Individual
STACIE COLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
1400 N RITTER AVE, STE 375B, INDIANAPOLIS, IN 46219-3052
(317) 355-9370
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002079A
IN
Other
Enumeration date
08/10/2016
Last updated
06/02/2017
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