Individual
STEPHANIE ANN FORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
1311 W 96TH ST, INDIANAPOLIS, IN 46260-1191
(765) 698-8192
Mailing address
PO BOX 304, CAMBRIDGE CITY, IN 47327-0304
(765) 698-8192
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28268154A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71016070A
IN
Other
Enumeration date
07/10/2024
Last updated
11/25/2024
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