Healthcare Provider Details

I. General information

NPI: 1336321215
Provider Name (Legal Business Name): SANDRA MARION STETZ R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3483 CLINTONVILLE RD
WATERFORD MI
48329-2227
US

IV. Provider business mailing address

3483 CLINTONVILLE RD
WATERFORD MI
48329-2227
US

V. Phone/Fax

Practice location:
  • Phone: 248-618-9368
  • Fax:
Mailing address:
  • Phone: 248-618-9368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number4704206474
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: