Provider Demographics
NPI:1992588859
Name:STINSON, JUAN
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:
Last Name:STINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15770 POND VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:MI
Mailing Address - Zip Code:48180-7806
Mailing Address - Country:US
Mailing Address - Phone:734-785-3697
Mailing Address - Fax:
Practice Address - Street 1:15770 POND VILLAGE DR
Practice Address - Street 2:
Practice Address - City:TAYLOR
Practice Address - State:MI
Practice Address - Zip Code:48180-7806
Practice Address - Country:US
Practice Address - Phone:734-785-3697
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide