Provider Demographics
NPI:1679586150
Name:STUMPF, YVONNE RAE (APRN)
Entity type:Individual
Prefix:
First Name:YVONNE
Middle Name:RAE
Last Name:STUMPF
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:YVONNE
Other - Middle Name:RAE
Other - Last Name:MCCAULLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, MSN,CS
Mailing Address - Street 1:5108 HICKORY TRL
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-9071
Mailing Address - Country:US
Mailing Address - Phone:810-695-1040
Mailing Address - Fax:
Practice Address - Street 1:441 S LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-2584
Practice Address - Country:US
Practice Address - Phone:248-608-8800
Practice Address - Fax:248-608-2490
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704122157364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult