Healthcare Provider Details

I. General information

NPI: 1033159553
Provider Name (Legal Business Name): NANNETTE STUMP PHD, HSPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0541
US

IV. Provider business mailing address

PO BOX 359
EVANSVILLE IN
47703-0359
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-5612
  • Fax: 812-485-5628
Mailing address:
  • Phone: 812-485-1220
  • Fax: 812-485-8544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20040400A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: