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NPI Code Detail

MEDICARE: CAROL A STULTS NP

MEDICARE: CAROL A STULTS NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP2300XPrimary Care Nurse Practitioner28072562AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1205115649
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROL A STULTS NP
Provider Business Mailing Address
First Line : 5649 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7145
Country : US
Telephone Number : 260-436-6565
Fax Number : 260-459-1130
Provider Business Practice Location Address
First Line : 5649 COVENTRY LN
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-7145
Country : US
Telephone Number : 260-436-6565
Fax Number : 260-459-1130
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2011
Last Update Date : 08/06/2012

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