Individual
CHERYL ANN STAHL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6301 UNIVERSITY COMMONS, SUITE 100, SOUTH BEND, IN 46635-1571
(574) 247-4667
(574) 271-4458
Mailing address
6301 UNIVERSITY COMMONS, SUITE 230, SOUTH BEND, IN 46635-1571
(574) 251-2100
(574) 251-2150
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28141968A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201016320
—
IN
01
—
264180009
MEDICARE
IN
01
—
P01089168
RAILROAD MEDICARE PTAN
IN
Enumeration date
05/21/2009
Last updated
09/29/2014
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