Provider Demographics
NPI:1427333467
Name:STRANTZ, SHANA MARIE (PA)
Entity type:Individual
Prefix:
First Name:SHANA
Middle Name:MARIE
Last Name:STRANTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:MARIE
Other - Last Name:SELESKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:212 S SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-1548
Practice Address - Country:US
Practice Address - Phone:231-924-1212
Practice Address - Fax:231-924-1449
Is Sole Proprietor?:No
Enumeration Date:2011-10-20
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601006180363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant