Healthcare Provider Details

I. General information

NPI: 1386215200
Provider Name (Legal Business Name): REBECCA STOTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2021
Last Update Date: 11/03/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 N MONROE ST
MONROE MI
48162-4211
US

IV. Provider business mailing address

333 N SUMMIT ST FL 7
TOLEDO OH
43604-1531
US

V. Phone/Fax

Practice location:
  • Phone: 734-240-8480
  • Fax: 734-384-0469
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704294778
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: