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General NPI Number Information
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NPI Number | 1679133086
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Entity Type | Individual
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Provider Name | STEPHANIE LOUISE TODD NP
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Gender | Female
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Dates
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Enumeration Date | 06/18/2019
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 204 E MUSKEGON ST
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City | CEDAR SPRINGS
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State | MI
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Zip | 49319-9326
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Country | US
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Telephone | 616-696-3470
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Fax |
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Provider Business Mailing Address
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Address Line | 4906 KIMBALL AVE SE
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City | GRAND RAPIDS
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State | MI
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Zip | 49508-4830
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Country | US
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Telephone | 616-560-0783
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 4704267067
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License Number State | MI
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