Provider Demographics
NPI:1194798181
Name:GARSTECK-POLAK, STEPHANIE ANN (CRNA)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:ANN
Last Name:GARSTECK-POLAK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:BRESSLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:44201 DEQUINDRE RD
Mailing Address - Street 2:ATTN SURGICAL SERVICES
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1117
Mailing Address - Country:US
Mailing Address - Phone:248-964-3012
Mailing Address - Fax:248-964-3012
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:ATTN SURGICAL SERVICES
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-3012
Practice Address - Fax:248-964-3012
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704153624367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI430042552OtherTRAVELERS MEDICARE
MISG153624OtherBLUE SHIELD
MI3227635Medicaid
MI0B56248033Medicare ID - Type UnspecifiedWPS