Individual provider Active NPI

Stephanie Dominique Gialdi Boerger, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Detroit, MI
National Provider Identifier
1548735483
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704314584 Issued in MI
Practice address
400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1599
Phone
(888) 731-8994
NPI assigned
Oct 8, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704314584 MI Primary

Addresses

Primary practice location

400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1599

Mailing address

400 Renaissance Ctr Ste 2600
Detroit, MI 48243-1599
Phone (888) 731-8994

Other practice location 1

100 Cambridge St Ste 1400
Boston, MA 02114-2545
Phone (888) 731-8994

Other practice location 2

20 Foundry St Fl 2
Concord, NH 03301-5419
Phone (888) 731-8994

Other practice location 3

700 Main St Ste 3
Bangor, ME 04401-6800
Phone (888) 731-8994

Other identifiers 1

IdentifierTypeStateIssuer
4704314584OtherMIBOARD OF NURSING

Other names 1

  • Stephanie Gialdi Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241202000459 MI Order and Referring Only - Nurse Practitioner 4385179217

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704314584MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Michigan Adult & Child Medicine Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1788912000000",
    "number": "1548735483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RENAISSANCE CTR STE 2600",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482431599",
            "telephone_number": "888-731-8994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 RENAISSANCE CTR STE 2600",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482431599",
            "telephone_number": "888-731-8994"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Cambridge St Ste 1400",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "021142545",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20 Foundry St Fl 2",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "NH",
            "postal_code": "033015419",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "700 Main St Ste 3",
            "address_purpose": "LOCATION",
            "city": "Bangor",
            "state": "ME",
            "postal_code": "044016800",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOERGER",
        "first_name": "STEPHANIE",
        "middle_name": "DOMINIQUE GIALDI",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-08",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704314584",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF NURSING",
            "identifier": "4704314584",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STEPHANIE",
            "last_name": "GIALDI",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.