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General NPI Number Information
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NPI Number | 1437873049
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Entity Type | Individual
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Provider Name | STACY LYNN COWHERD LPN
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Gender | Female
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Dates
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Enumeration Date | 09/27/2022
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 5550 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46219-6426
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Country | US
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Telephone | 317-352-9157
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Fax | 317-359-4052
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Provider Business Mailing Address
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Address Line | 1720 N BOLTON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46218-5133
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Country | US
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Telephone | 317-625-4023
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 27059681A
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License Number State | IN
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