Healthcare Provider Details

I. General information

NPI: 1598568495
Provider Name (Legal Business Name): LARISSA STECIAK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2025
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34330 PINEWOODS CIR APT 206
ROMULUS MI
48174-8231
US

IV. Provider business mailing address

34330 PINEWOODS CIR APT 206
ROMULUS MI
48174-8231
US

V. Phone/Fax

Practice location:
  • Phone: 313-888-5475
  • Fax:
Mailing address:
  • Phone: 313-888-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number4704420218
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: