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General NPI Number Information
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NPI Number | 1841851821
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Entity Type | Individual
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Provider Name | STEPHANIE NULTY MD, MBA
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Gender | Female
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Dates
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Enumeration Date | 06/21/2019
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 26850 PROVIDENCE PKWY STE 260
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City | NOVI
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State | MI
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Zip | 48374-1256
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Country | US
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Telephone | 248-465-5140
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 14128
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City | BELFAST
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State | ME
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Zip | 04915-4032
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Country | US
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Telephone | 248-680-8000
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301513789
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License Number State | MI
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