Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | F09191538 | IN |
NPI | 1003485574 |
---|---|
Provider Name | Samantha Lee Stalnaker |
First Address | Brownsburg, IN 46112-5608 |
Second Address | Indianapolis, IN 46205-1377 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2021 |
Last Update Date | 21/06/2021 |