Individual
MRS. JENELLE HALEY STEFANSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6913 N MAIN ST STE 100, GRANGER, IN 46530-8039
(574) 647-6400
(574) 647-2951
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
4704278821
MI
363LF0000X
Family Nurse Practitioner
2013007660
MI
363LF0000X
Family Nurse Practitioner
Primary
71004799A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201215000
—
IN
Enumeration date
09/09/2013
Last updated
02/05/2019
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