Provider Demographics
NPI:1245190891
Name:BROWN, STEPHANIE WATFORD
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:WATFORD
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7999 JEREMY RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48111-5383
Mailing Address - Country:US
Mailing Address - Phone:757-438-9475
Mailing Address - Fax:
Practice Address - Street 1:7999 JEREMY RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48111-5383
Practice Address - Country:US
Practice Address - Phone:757-438-9475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-11-17
Last Update Date:2025-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care