Healthcare Provider Details

I. General information

NPI: 1053757047
Provider Name (Legal Business Name): STEPHANIE L. DAVITTO N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 09/13/2024
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 SAGAMORE PKWY WEST
WEST LAFAYETTE IN
47906
US

IV. Provider business mailing address

124 SAGAMORE PKWY WEST
WEST LAFAYETTE IN
47906
US

V. Phone/Fax

Practice location:
  • Phone: 765-463-6722
  • Fax: 765-463-0905
Mailing address:
  • Phone: 765-463-6722
  • Fax: 765-463-0905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71004424A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: