Healthcare Provider Details

I. General information

NPI: 1134544190
Provider Name (Legal Business Name): STEPHANIE MICHELE STANLEY APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2014
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N MERIDIAN ST STE 275
CARMEL IN
46032-1484
US

IV. Provider business mailing address

13430 N MERIDIAN ST STE 275
CARMEL IN
46032-1484
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-8810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28224960A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011559A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: