Healthcare Provider Details

I. General information

NPI: 1861207334
Provider Name (Legal Business Name): STEFANIE SIMONETTA PRC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 STODDARD RD
RICHMOND MI
48062-2505
US

IV. Provider business mailing address

400 STODDARD RD
RICHMOND MI
48062-2505
US

V. Phone/Fax

Practice location:
  • Phone: 810-392-2167
  • Fax: 810-392-3530
Mailing address:
  • Phone: 810-392-2167
  • Fax: 810-392-3530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: