Provider Demographics
NPI:1316918659
Name:SMILEY, STEPHANIE L (PHYSICIAN ASST C)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:L
Last Name:SMILEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASST C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:WRASS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHYSICIAN ASST C
Mailing Address - Street 1:37399 GARFIELD RD
Mailing Address - Street 2:STE 104
Mailing Address - City:CLINTON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3672
Mailing Address - Country:US
Mailing Address - Phone:586-569-3379
Mailing Address - Fax:586-576-6264
Practice Address - Street 1:37399 GARFIELD RD
Practice Address - Street 2:STE 104
Practice Address - City:CLINTON TWP
Practice Address - State:MI
Practice Address - Zip Code:48036-3672
Practice Address - Country:US
Practice Address - Phone:586-286-5400
Practice Address - Fax:586-576-6264
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MI5601004700363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant