Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | 5151015209 | MI |
NPI | 1033781828 |
---|---|
Provider Name | Katherine Stephens |
First Address | Temperance, MI 48182-9817 |
Second Address | Monroe, MI 48162-7815 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2021 |
Last Update Date | 12/07/2021 |