Healthcare Provider Details

I. General information

NPI: 1912829532
Provider Name (Legal Business Name): MRS. STEFANIE BISESI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N INGALLS ST
ANN ARBOR MI
48109-2003
US

IV. Provider business mailing address

24505 SHERBECK DR
CLINTON TOWNSHIP MI
48036-2856
US

V. Phone/Fax

Practice location:
  • Phone: 760-792-0425
  • Fax:
Mailing address:
  • Phone: 760-792-0425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704426313
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: