Healthcare Provider Details

I. General information

NPI: 1770383689
Provider Name (Legal Business Name): ANGIE STINSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2025
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

836 N DETROIT ST
LAGRANGE IN
46761-1112
US

IV. Provider business mailing address

75 W CENTER DR
COLUMBIA CITY IN
46725-8605
US

V. Phone/Fax

Practice location:
  • Phone: 260-499-3019
  • Fax: 260-499-3022
Mailing address:
  • Phone: 260-503-4736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71016026A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: