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NPI Code Detail

MEDICARE: STEPHANIE DOMINIQUE GIALDI BOERGER NURSE PRACTITIONER

MEDICARE: STEPHANIE DOMINIQUE GIALDI BOERGER NURSE PRACTITIONER
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
1363LF0000XFamily Nurse Practitioner4704314584MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
14704314584OTHERMIBOARD OF NURSING

General Provider Information

NPI Number : 1548735483
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE DOMINIQUE GIALDI BOERGER NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 400 RENAISSANCE CTR STE 2600
Second Line :
City : DETROIT
State : MI
Zip : 48243-1599
Country : US
Telephone Number : 888-731-8994
Fax Number :
Provider Business Practice Location Address
First Line : 400 RENAISSANCE CTR STE 2600
Second Line :
City : DETROIT
State : MI
Zip : 48243-1599
Country : US
Telephone Number : 888-731-8994
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/08/2018
Last Update Date : 12/10/2025

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