Provider Demographics
NPI:1174168892
Name:STOWE, HALEY CARISSA (FNP)
Entity type:Individual
Prefix:
First Name:HALEY
Middle Name:CARISSA
Last Name:STOWE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HALEY
Other - Middle Name:CARISSA
Other - Last Name:DINSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3048 GEHRING DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48506-2262
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1192 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-5518
Practice Address - Country:US
Practice Address - Phone:810-535-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704350735363L00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care