QUIANA LYNELL STEPHENS-MACK (NPI# 1770832966) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770832966 |
| Entity Type | Individual |
| Full Name | QUIANA LYNELL STEPHENS-MACK |
| Credential | MSN CPNP |
| Practice Address |
12800 Kelly Rd St John Health Center, Rm 102b Detroit MI 48224-1506 |
| Mailing Address |
22475 Culpeper Dr Clinton Township MI 48035-4245 |
| Practice Telephone | 3133723826 |
| Practice Fax Number | 3133723990 |
| Mailing Telephone | 3135497406 |
| Enumeration Date | 2012-09-04 |
| Last Update Date | 2019-02-12 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | 4704245159 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
4704245159 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1164553099 | 05 | |
| MI | BC IND PIN | 5008721450 | 01 |
| Street Address |
12800 KELLY RD ST JOHN HEALTH CENTER, RM 102B |
| City | DETROIT |
| State | MI |
| Zip Code | 48224-1506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669726469 | Delilah Bolis | Counselor | 12800 Kelly Rd, Detroit, MI 48224-1506 | 2012-10-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508403767 | Renia Scott | Licensed Practical Nurse | 5211 Berkshire St, Detroit, MI 48224 | 2019-12-06 |
| 1063928612 | Edith Neely-harris | Registered Nurse | 1203 Courville Street, Detroit, MI 48224 | 2017-12-19 |
| 1043767585 | Annette Jackson | Counselor | 10666 Duprey St, Detroit, MI 48224 | 2016-09-01 |
| 1164977807 | Dehvin White-peck | Technician, Other | 4529 Harvard Rd, Detroit, MI 48224 | 2016-08-23 |
| 1992153704 | Andrea Henderson | Licensed Practical Nurse | 9131 Bradford, Detroit, MI 48224 | 2016-06-02 |
| 1467807578 | Venus Staffing LLC | Nursing Care | 5601 Devonshire Rd, Detroit, MI 48224 | 2016-04-26 |
| 1558795625 | Rafia El-alayli | Internal Medicine | 9901 Whittier Ave, Detroit, MI 48224 | 2013-08-26 |
| 1831334259 | House of Hearts Ministry, Inc. | Voluntary or Charitable | 11151 Worden, Detroit, MI 48224 | 2008-12-15 |
| 1992994636 | Lilian Lai Md PC | Clinic/Center | 15850 E Warren Ave, Detroit, MI 48224 | 2007-10-18 |
| 1184845844 | Tymon C Totte | Dentist | 17700 Mack Ave, Great Expressions Dental Centers, Gross Pointe, MI 48224 | 2007-05-01 |
| Find all providers in zip 48224 | ||||
| Taxonomy Code | 363LP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Pediatrics |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376913822 | Michael J. Mooney | Nurse Practitioner | 3901 Beaubien, 3rd Floor Carl's Bldg,, #3g32, Children's Hospital of Mi, Detroit, MI 48201-2153 | 2015-09-28 |
| 1295079895 | Mia Love | Nurse Practitioner | 2959 Martin Luther King Jr Blvd, Detroit, MI 48208 | 2012-11-20 |
| 1164773099 | Fatima Mays | Nurse Practitioner | 5020 Cadieux, Detroit, MI 48224-2153 | 2012-10-02 |
| 1891027173 | Ruth Alma Roeder | Nurse Practitioner | 3901 Beaubien 3rd Floor Main Bldg, Children's Hospital of Mi, Detroit, MI 48201 | 2010-02-11 |
| 1265584171 | April K Morris | Nurse Practitioner | 3901 Beaubien - Er Dept, Children's Hospital of Mi, Detroit, MI 48201 | 2007-01-18 |
| 1336299767 | Patricia Sue Beierwaltes | Nurse Practitioner | Children's Hospital of Michigan, 3901 Beaubien Blvd., Detroit, MI 48201 | 2007-01-10 |
| 1508921388 | Tina Marcia Almanza | Nurse Practitioner | 1903 Wilkins St, Detroit, MI 48207-2112 | 2006-12-22 |
| 1871656629 | Sylvia Lou Smith | Nurse Practitioner | 8820 Woodrow Wilson St, Hutchins Health Center (henry Ford Health System), Detroit, MI 48206-2216 | 2006-12-19 |
| 1194762195 | Heather L Bartlett | Nurse Practitioner | 3950 Beaubien, Childrens Hospital of Mi, Detroit, MI 48201 | 2006-05-31 |
| 1033188099 | Cathy Patty-resk | Nurse Practitioner | Children's Hospital of Mi, 3950 Beaubien, Detroit, MI 48201 | 2006-03-14 |
| Find all providers in DETROIT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.