Individual
STACIE L HOUSHOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3909 NEW VISION DR, FORT WAYNE, IN 46845-1725
(260) 469-6602
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71004055A
IN
Other
Enumeration date
08/02/2012
Last updated
10/20/2022
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