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Individual

STEPHANIE DAVIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MPA

Contact information

Practice address
4448 ADAMS ST, GARY, IN 46408-3346
(800) 883-5373
Mailing address
4448 ADAMS ST, GARY, IN 46408-3346
(800) 883-5373

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
0550225067
IN

Other

Enumeration date
05/08/2019
Last updated
05/08/2019
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