Healthcare Provider Details

I. General information

NPI: 1053749838
Provider Name (Legal Business Name): STEPHANIE DRAZER FORD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2013
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 GLENDALE BLVD
VALPARAISO IN
46383-3724
US

IV. Provider business mailing address

2931 GLENWOOD BEACH TRL
PORTER IN
46304-3422
US

V. Phone/Fax

Practice location:
  • Phone: 219-384-8181
  • Fax:
Mailing address:
  • Phone: 219-384-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71017342
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: