Individual
ANDREA CHRISTINE STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
8040 CLEARVISTA PKWY, STE 460, INDIANAPOLIS, IN 46256-5630
(317) 621-2660
(317) 621-1535
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71006135A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71006135A
IN
363LP0200X
Pediatric Nurse Practitioner
RN185930
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201350080
—
IN
01
—
P01678745
MEDICARE RR
IN
Enumeration date
11/13/2007
Last updated
11/06/2024
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