Healthcare Provider Details

I. General information

NPI: 1083190870
Provider Name (Legal Business Name): MAIRE STOCKING APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MAIRE STOCKING FLOOD

II. Dates (important events)

Enumeration Date: 07/14/2018
Last Update Date: 07/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 LAFAYETTE RD STE 200
INDIANAPOLIS IN
46222-1147
US

IV. Provider business mailing address

3400 LAFAYETTE RD STE 200
INDIANAPOLIS IN
46222-1147
US

V. Phone/Fax

Practice location:
  • Phone: 317-291-7422
  • Fax:
Mailing address:
  • Phone: 317-291-7422
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71008088A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: