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General NPI Number Information
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NPI Number | 1912414756
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Entity Type | Individual
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Provider Name | STEPHANIE LIM NP
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Gender | Female
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Dates
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Enumeration Date | 01/02/2018
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 17900 23 MILE RD
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City | MACOMB
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State | MI
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Zip | 48044-1161
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Country | US
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Telephone | 586-868-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 54148 AUDUBON DR
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City | MACOMB
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State | MI
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Zip | 48042-2398
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704281857
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | 4704281857
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2022091964
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License Number State | MI
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