Healthcare Provider Details

I. General information

NPI: 1649725151
Provider Name (Legal Business Name): STUART ALLAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STUART A ALLAN DNP, FC-BC

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 09/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MACARTHUR BLVD STE 404
MUNSTER IN
46321-2919
US

IV. Provider business mailing address

4501 BLAIR LN
VALPARAISO IN
46383-9164
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-2995
  • Fax:
Mailing address:
  • Phone: 219-286-3494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28182561A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006523A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: