Healthcare Provider Details

I. General information

NPI: 1255535878
Provider Name (Legal Business Name): STEPHANIE GABY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 BROADWAY ST
INDIANAPOLIS IN
46202-2737
US

IV. Provider business mailing address

1208 BROADWAY ST
INDIANAPOLIS IN
46202-2737
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-7435
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number28168423A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: