Healthcare Provider Details

I. General information

NPI: 1033896188
Provider Name (Legal Business Name): JENNIFER DAWN STONE PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9250 COLUMBIA AVE STE 2E
MUNSTER IN
46321-3530
US

IV. Provider business mailing address

235 FAIRCHILD DR
BURNS HARBOR IN
46304-9227
US

V. Phone/Fax

Practice location:
  • Phone: 219-595-0043
  • Fax: 219-237-2894
Mailing address:
  • Phone: 614-557-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71014064A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: