Provider Demographics
NPI:1699243089
Name:STOWE, MIA (FNP-C)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:STOWE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7667 E PRIVATE ROAD 375 N
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47868-6843
Mailing Address - Country:US
Mailing Address - Phone:812-531-3115
Mailing Address - Fax:
Practice Address - Street 1:7667 E PRIVATE ROAD 375 N
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:IN
Practice Address - Zip Code:47868-6843
Practice Address - Country:US
Practice Address - Phone:812-531-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28204833A163W00000X
INF10181513363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse