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General NPI Number Information
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NPI Number | 1083664643
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Entity Type | Individual
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Provider Name | STEPHANIE A REAGAN NP
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Gender | Female
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 124 E MAIN ST
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City | MUNCIE
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State | IN
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Zip | 47305-2839
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Country | US
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Telephone | 765-587-7311
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Fax |
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Provider Business Mailing Address
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Address Line | 124 E MAIN ST
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City | MUNCIE
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State | IN
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Zip | 47305-2839
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Country | US
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Telephone | 765-587-7311
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71001099A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71001099A
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License Number State | IN
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