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STEPHANIE LYNN PRESTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CRNA

Contact information

Practice address
811 S 9TH ST, LAFAYETTE, IN 47905-5545
(765) 742-4950
Mailing address
811 S 9TH ST, LAFAYETTE, IN 47905-5545
(765) 742-4950

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
019755
OH
367500000X
Certified Registered Nurse Anesthetist
209014268
IL
367500000X
Certified Registered Nurse Anesthetist
Primary
28140106A
IN
367500000X
Certified Registered Nurse Anesthetist
4704239128
MI
367500000X
Certified Registered Nurse Anesthetist
9485336
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000479193
ANTHEM PROVIDER NUMBER
IN
05
200822890
IN
01
9434123
PHCS PID NUMBER
IN
Enumeration date
04/21/2006
Last updated
11/24/2018
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