Healthcare Provider Details

I. General information

NPI: 1790377331
Provider Name (Legal Business Name): STEPHEN GLEN MARKHAM RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2021
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST
ADRIAN MI
49221-1759
US

IV. Provider business mailing address

51350 FORD RD
CANTON MI
48187-4638
US

V. Phone/Fax

Practice location:
  • Phone: 517-263-1800
  • Fax:
Mailing address:
  • Phone: 734-560-6765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704326909
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4704326909
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: