Individual
STACY R BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 10, FORT WAYNE, IN 46845-1733
(260) 425-6070
(260) 425-6073
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71012324A
IN
Other
Enumeration date
02/18/2022
Last updated
04/02/2025
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