Individual
DANA L STADDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
7601 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4133
(260) 436-8686
Mailing address
PO BOX 2526, FORT WAYNE, IN 46801-2526
(260) 436-8686
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP09146
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71011484A
IN APRN LICENSE
IN
01
—
AP09146
LA APRN LICENSE
LA
01
—
F1216399
AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION
—
Enumeration date
01/20/2017
Last updated
02/11/2024
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