Basic Information
Provider Information
NPI: 1619355641
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STERNEMANN
FirstName: MEGHAN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 13008
Address2:  
City: LANSING
State: MI
PostalCode: 489013008
CountryCode: US
TelephoneNumber: 5173646253
FaxNumber: 5173646204
Practice Location
Address1: 2682 E GRAND RIVER AVE
Address2:  
City: EAST LANSING
State: MI
PostalCode: 488235608
CountryCode: US
TelephoneNumber: 5173336562
FaxNumber: 5173336563
Other Information
ProviderEnumerationDate: 05/11/2015
LastUpdateDate: 05/11/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTitleorPosition:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X4704279610MIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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