Individual
STACY L POTILA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CST/CFA
Contact information
Practice address
1801 SENATE BLVD, # 200, INDIANAPOLIS, IN 46202-1228
(317) 802-2000
(317) 924-0115
Mailing address
1801 SENATE BLVD, # 200, INDIANAPOLIS, IN 46202-1228
(317) 802-2000
(317) 924-0115
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000374454
ANTHEM
IN
Enumeration date
06/30/2006
Last updated
07/08/2007
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