Basic Information
Provider Information | |||||||||
NPI: | 1174834055 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | DOWNING | ||||||||
FirstName: | STEPHANIE | ||||||||
MiddleName: | RAE | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2080 CELADON DR NE | ||||||||
Address2: |   | ||||||||
City: | GRAND RAPIDS | ||||||||
State: | MI | ||||||||
PostalCode: | 495253914 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2023758050 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 26520 CACTUS AVE | ||||||||
Address2: |   | ||||||||
City: | MORENO VALLEY | ||||||||
State: | CA | ||||||||
PostalCode: | 925553927 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9514864000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/25/2010 | ||||||||
LastUpdateDate: | 05/14/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/14/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 4301108085 | MI | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 208600000X | MD60445640 | WA | N |   | Allopathic & Osteopathic Physicians | Surgery |   | 2086S0102X | 37504 | OK | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | A127403 | CA | Y |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 4301108085 | MI | N |   | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care |
No ID Information.