Individual
STEPHANIE DAUGHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1200 BARR ST, FORT WAYNE, IN 46802-3502
(260) 467-1100
Mailing address
1200 BARR ST, FORT WAYNE, IN 46802-3502
(260) 467-1100
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
IN
Other
Enumeration date
04/21/2025
Last updated
04/21/2025
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