Healthcare Provider Details

I. General information

NPI: 1104153766
Provider Name (Legal Business Name): STEPHANIE LYNN SMITH MSN, WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: STEPHANIE BREINING WHNP-BC

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 RENAISSANCE CTR STE 2600
DETROIT MI
48243-1599
US

IV. Provider business mailing address

400 RENAISSANCE CTR STE 2600
DETROIT MI
48243-1599
US

V. Phone/Fax

Practice location:
  • Phone: 989-277-4077
  • Fax:
Mailing address:
  • Phone: 989-277-4077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number4704253301
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberTPAN2221
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: