Healthcare Provider Details

I. General information

NPI: 1851952709
Provider Name (Legal Business Name): STACY CHRISTINE GOLDTHORPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 CONNABLE AVE
PETOSKEY MI
49770-2212
US

IV. Provider business mailing address

602 JACKSON ST
PETOSKEY MI
49770-2220
US

V. Phone/Fax

Practice location:
  • Phone: 231-348-2795
  • Fax: 231-348-2031
Mailing address:
  • Phone: 231-348-2795
  • Fax: 231-348-2031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: