MEDICARE: STACHIA LEIGH MYERS DON RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28222938A	IN

General Provider Information

NPI Number	:	1477263507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACHIA LEIGH MYERS DON RN

Provider Business Mailing Address
First Line	:	1818 CRYSTAL ST
Second Line	:
City	:	ANDERSON
State	:	IN
Zip	:	46012-2415
Country	:	US
Telephone Number	:	765-621-4598
Fax Number	:

Provider Business Practice Location Address
First Line	:	524 ANDERSON RD
Second Line	:
City	:	CHESTERFIELD
State	:	IN
Zip	:	46017-1514
Country	:	US
Telephone Number	:	765-378-0213
Fax Number	:	765-378-7471

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2022
Last Update Date	:	11/30/2022

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