Healthcare Provider Details

I. General information

NPI: 1972854792
Provider Name (Legal Business Name): STEPHANIE KACHALLA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ROSLONSKI NP-C

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 12/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BARCLAY CIR SUITE 225
ROCHESTER HILLS MI
48307-5820
US

IV. Provider business mailing address

75 BARCLAY CIR SUITE 225
ROCHESTER HILLS MI
48307-5820
US

V. Phone/Fax

Practice location:
  • Phone: 248-299-1892
  • Fax:
Mailing address:
  • Phone: 248-299-1892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number22383
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number4704253075
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: