Provider Demographics
NPI:1407281496
Name:MACCONNEL, STEPHANIE ANN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:MACCONNEL
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:MS
Other - First Name:STEPHANIE
Other - Middle Name:ANN
Other - Last Name:STUCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:291 EDEN STREET
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:MI
Mailing Address - Zip Code:49649
Mailing Address - Country:US
Mailing Address - Phone:734-320-4417
Mailing Address - Fax:231-392-2424
Practice Address - Street 1:1105 SIXTH STREET
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684
Practice Address - Country:US
Practice Address - Phone:231-392-0630
Practice Address - Fax:231-935-5885
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006787363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant