Provider Demographics
NPI:1073899142
Name:STOCK, PAULA JANE (RN, MSN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:JANE
Last Name:STOCK
Suffix:
Gender:F
Credentials:RN, MSN, FNP-BC
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Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:734-632-0182
Practice Address - Street 1:18101 OAKWOOD BLVD
Practice Address - Street 2:ISU OBSERVATION UNIT
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48124-4089
Practice Address - Country:US
Practice Address - Phone:313-982-5770
Practice Address - Fax:313-982-5771
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704114321363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12315347OtherCAQH