Active NPI
Stacy Shattuck
- Other Technician
- Midland, MI
National Provider Identifier
1164899100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- Practice address
- 4512 N Saginaw Rd Apt 812
Midland, MI 48640-2357 - Phone
- (989) 620-6875
- NPI assigned
- Aug 25, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | Primary |
Addresses
Primary practice location
4512 N Saginaw Rd Apt 812
Midland, MI 48640-2357
Mailing address
4512 N Saginaw Rd Apt 812
Midland, MI 48640-2357
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1440460800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1440460800000",
"number": "1164899100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4512 N SAGINAW RD APT 812",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486402357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4512 N SAGINAW RD APT 812",
"city": "MIDLAND",
"state": "MI",
"postal_code": "486402357",
"telephone_number": "989-620-6875"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHATTUCK",
"first_name": "STACY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-25",
"last_updated": "2015-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Midland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.