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General NPI Number Information
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NPI Number | 1548925993
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Entity Type | Organization
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Legal Business Name | STT MEDICAL PLLC
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Dates
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Enumeration Date | 11/01/2021
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Last Update Date | 11/01/2021
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Provider Practice Location Address
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Address Line | 8565 N SILVERY LN STE 100
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City | DEARBORN HEIGHTS
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State | MI
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Zip | 48127-4517
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Country | US
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Telephone | 313-258-7335
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Fax |
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Provider Business Mailing Address
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Address Line | 6972 SOLOMON AVE
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City | TROY
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State | MI
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Zip | 48085-1290
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Country | US
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Telephone | 313-258-7335
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STACEY TERRELL TAYLOR
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Credential | MSN, APRN, FNP-C
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Telephone | 313-258-7335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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