Individual
STEPHANIE MACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3030 N OLNEY ST, INDIANAPOLIS, IN 46218-2131
(317) 728-6862
Mailing address
3030 N OLNEY ST, INDIANAPOLIS, IN 46218-2131
(317) 728-6862
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06061967
—
IN
Enumeration date
09/01/2022
Last updated
09/01/2022
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