Provider Demographics
NPI:1942040100
Name:SWEENEY, STEPHANIE JO (MSN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JO
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:MISS
Other - First Name:STEPHANIE
Other - Middle Name:JO
Other - Last Name:MAAT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 LEFFINGWELL AVE NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49525-6406
Mailing Address - Country:US
Mailing Address - Phone:616-459-7101
Mailing Address - Fax:616-464-6170
Practice Address - Street 1:555 MIDTOWNE ST NE STE 105
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-5731
Practice Address - Country:US
Practice Address - Phone:616-459-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301147163WX0800X, 363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily