Basic Information
| Provider Information | |||||||||
| NPI: | 1437632874 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HINTON | ||||||||
| FirstName: | STACEY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 S BRIDGE ST UNIT 47 | ||||||||
| Address2: | |||||||||
| City: | DEWITT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488208855 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1033 HEALTHCARE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488131058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175410992 | ||||||||
| FaxNumber: | 5175410993 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2018 | ||||||||
| LastUpdateDate: | 06/25/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | 4704252164 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 363LF0000X | 4704252164 | MI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.