Healthcare Provider Details

I. General information

NPI: 1205210861
Provider Name (Legal Business Name): JANA STEDMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 07/04/2024
Certification Date: 07/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8063 MADISON AVE # 527
INDIANAPOLIS IN
46227-6001
US

IV. Provider business mailing address

PO BOX 3231
MUNSTER IN
46321-0231
US

V. Phone/Fax

Practice location:
  • Phone: 219-200-2022
  • Fax:
Mailing address:
  • Phone: 219-200-2022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10002344A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085005550
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: