Provider Demographics
NPI:1124673215
Name:JONES, STEFANEE (NP)
Entity type:Individual
Prefix:
First Name:STEFANEE
Middle Name:
Last Name:JONES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STEFANEE
Other - Middle Name:
Other - Last Name:DZIWIRSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:11410 CHAREST ST
Mailing Address - Street 2:
Mailing Address - City:HAMTRAMCK
Mailing Address - State:MI
Mailing Address - Zip Code:48212-3025
Mailing Address - Country:US
Mailing Address - Phone:313-891-9473
Mailing Address - Fax:
Practice Address - Street 1:11410 CHAREST ST
Practice Address - Street 2:
Practice Address - City:HAMTRAMCK
Practice Address - State:MI
Practice Address - Zip Code:48212-3025
Practice Address - Country:US
Practice Address - Phone:313-891-9473
Practice Address - Fax:313-892-1750
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704284470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily