Individual
JULIE R. STACKHOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
2414 E STATE BLVD, SUITE 101, FORT WAYNE, IN 46805-4760
(260) 422-7455
(260) 422-0086
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001177A
IN
367A00000X
Advanced Practice Midwife
09000127A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200847020
—
IN
Enumeration date
01/18/2007
Last updated
01/30/2020
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