Individual
CAROL A STULTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5649 COVENTRY LN, FORT WAYNE, IN 46804-7145
(260) 436-6565
(260) 459-1130
Mailing address
5649 COVENTRY LN, FORT WAYNE, IN 46804-7145
(260) 436-6565
(260) 459-1130
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
28072562A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201039990
—
IN
Enumeration date
08/16/2011
Last updated
08/06/2012
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