Healthcare Provider Details

I. General information

NPI: 1457687279
Provider Name (Legal Business Name): STEPHANIE BRICKLYN NEWHOUSE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 12/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SOUTH BLVD E STE 160
ROCHESTER HILLS MI
48307-6124
US

IV. Provider business mailing address

1701 SOUTH BLVD E STE 160
ROCHESTER HILLS MI
48307-6124
US

V. Phone/Fax

Practice location:
  • Phone: 248-598-5080
  • Fax:
Mailing address:
  • Phone: 248-598-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number4704253147
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: