Healthcare Provider Details

I. General information

NPI: 1679808182
Provider Name (Legal Business Name): STEPHANIE NORMAN MSN, NNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 S 31ST ST ATTN: NEONATAL INTENSIVE CARE UNIT
TEMPLE TX
76508-0001
US

IV. Provider business mailing address

1 FORD PL STE 3A
DETROIT MI
48202-3450
US

V. Phone/Fax

Practice location:
  • Phone: 254-724-4349
  • Fax:
Mailing address:
  • Phone: 313-874-4806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number4704385985
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number657138
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: