Healthcare Provider Details

I. General information

NPI: 1194798181
Provider Name (Legal Business Name): STEPHANIE ANN GARSTECK-POLAK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE ANN BRESSLER CRNA

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD ATTN SURGICAL SERVICES
TROY MI
48085-1117
US

IV. Provider business mailing address

44201 DEQUINDRE RD ATTN SURGICAL SERVICES
TROY MI
48085-1117
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-3012
  • Fax: 248-964-3012
Mailing address:
  • Phone: 248-964-3012
  • Fax: 248-964-3012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4704153624
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: