Provider Demographics
NPI:1386975084
Name:MAYNE, STEPHANIE ARLENE
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ARLENE
Last Name:MAYNE
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 1:1229 SYLVAN AVE SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-3934
Mailing Address - Country:US
Mailing Address - Phone:616-706-1040
Mailing Address - Fax:616-248-8688
Practice Address - Street 1:1229 SYLVAN AVE SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-3934
Practice Address - Country:US
Practice Address - Phone:616-706-1040
Practice Address - Fax:616-248-8688
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-19
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula