Individual
STACY L MC DOWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
621 MEMORIAL DR STE 312, SOUTH BEND, IN 46601-1073
(574) 647-5200
(574) 647-5210
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
71003872A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000769085
BCBS BMG VASCULAR INTERVENTIONAL RAD
IN
05
—
201006430
—
IN
01
—
P01146029
RR MEDICARE
IN
Enumeration date
12/01/2010
Last updated
04/16/2018
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