Individual
MRS. JESSICA STOMBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
975 MEZZANINE DR STE C, LAFAYETTE, IN 47905-8635
(765) 446-5220
(765) 446-5221
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28165476A
IN
363L00000X
Nurse Practitioner
Primary
71012747A
IN
Other
Enumeration date
09/05/2021
Last updated
07/07/2022
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