Basic Information
| Provider Information | |||||||||
| NPI: | 1003285024 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HEBBERD | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PERUSKI | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | A | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 120 N DELAWARE ST | ||||||||
| Address2: | |||||||||
| City: | SANDUSKY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484711009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106480561 | ||||||||
| FaxNumber: | 8106483352 | ||||||||
| Practice Location | |||||||||
| Address1: | 251 E PECK RD | ||||||||
| Address2: | |||||||||
| City: | PECK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 484669589 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8103784900 | ||||||||
| FaxNumber: | 8103784905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2015 | ||||||||
| LastUpdateDate: | 08/29/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 4704282943 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.