Healthcare Provider Details

I. General information

NPI: 1124807136
Provider Name (Legal Business Name): STACEY ELIZABETH UGARTECHEA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 W SAGINAW RD
SANFORD MI
48657-9206
US

IV. Provider business mailing address

4000 WELLNESS DR
MIDLAND MI
48670-1000
US

V. Phone/Fax

Practice location:
  • Phone: 989-687-9940
  • Fax: 989-687-9945
Mailing address:
  • Phone: 844-832-1956
  • Fax: 989-644-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704311291
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: