| Doctor Name: | STACEY BONECUTTER |
| NPI Number: | 1194139527 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP |
| License Number: | 4704217372 |
| Business Practice Address: | 315 Oakgrove St Manistee, MI - 496601176 |
| Business Phone Number: | 2313981950 |
| Business Fax Number: | 2313989268 |
| Mailing Address: | 1400 E Parkdale Ave, MANISTEE |
| State: | MI |
| Postal Code: | 496609776 |
| Phone Number: | 2313981840 |
| Fax Number: | 2313981835 |
| NPI Enumeration Date: | 06/13/2014 |
| NPI Last Update Date: | 06/13/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 4704217372 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |