# STACEY PHIPPS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1265716146
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | 32001430A | IN | Yes |

## Other

- **Enumeration date:** 10/10/2011
- **Last updated:** 10/10/2011