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General NPI Number Information
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NPI Number | 1942040100
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Entity Type | Individual
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Provider Name | STEPHANIE JO SWEENEY MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 05/27/2024
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Last Update Date | 10/14/2024
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Provider Practice Location Address
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Address Line | 555 MIDTOWNE ST NE STE 105
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-5731
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Country | US
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Telephone | 616-459-7101
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Fax |
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Provider Business Mailing Address
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Address Line | 1111 LEFFINGWELL AVE NE
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City | GRAND RAPIDS
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State | MI
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Zip | 49525-6406
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Country | US
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Telephone | 616-459-7101
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Fax | 616-464-6170
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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 | 163WX0800X
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Taxonomy Name | Orthopedic Registered Nurse
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License Number | 4704301147
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4704301147
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704301147
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License Number State | MI
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