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Individual
STACY MARIE SMITH
Active
Individual
STACY MARIE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28131467A
IN
207Q00000X
Family Medicine Physician
Primary
351434141
IN
363LF0000X
Family Nurse Practitioner
71003749A
IN
Other
Enumeration date
09/26/2011
Last updated
12/31/2019
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