MEDICARE: STEPHANIE JO PRICE RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WE0003X	Emergency Registered Nurse	28218358A	IN

General Provider Information

NPI Number	:	1164228813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE JO PRICE RN

Provider Business Mailing Address
First Line	:	71015 KESSINGTON RD
Second Line	:
City	:	UNION
State	:	MI
Zip	:	49130-9638
Country	:	US
Telephone Number	:	574-333-4903
Fax Number	:

Provider Business Practice Location Address
First Line	:	71015 KESSINGTON RD
Second Line	:
City	:	UNION
State	:	MI
Zip	:	49130-9638
Country	:	US
Telephone Number	:	574-333-4903
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2025
Last Update Date	:	02/24/2025

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Directions to “ STEPHANIE JO PRICE RN” Practice Location

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