Individual
ELLEN STOLYAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2477
(765) 448-8000
(765) 838-5150
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
(765) 448-8085
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28185576A
IN
367500000X
Certified Registered Nurse Anesthetist
Primary
CERT# 084038
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000636144
ANTHEM PROVIDER NUMBER
IN
05
—
200965640
—
IN
Enumeration date
05/11/2009
Last updated
04/19/2010
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