Individual
STACEY PATRICE CADOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 751-1449
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71004604A
IN
363LA2100X
Acute Care Nurse Practitioner
28210327A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71004604A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201187760
—
IN
01
—
P01438113
RAILROAD MEDICARE
IN
Enumeration date
07/22/2013
Last updated
12/17/2020
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