Provider Demographics
NPI:1902652852
Name:PFAFF, STACIE LYNN (FNP)
Entity type:Individual
Prefix:
First Name:STACIE
Middle Name:LYNN
Last Name:PFAFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 S DENNY HILL RD
Mailing Address - Street 2:
Mailing Address - City:PARAGON
Mailing Address - State:IN
Mailing Address - Zip Code:46166-9594
Mailing Address - Country:US
Mailing Address - Phone:765-318-6636
Mailing Address - Fax:
Practice Address - Street 1:1444 S DENNY HILL RD
Practice Address - Street 2:
Practice Address - City:PARAGON
Practice Address - State:IN
Practice Address - Zip Code:46166-9594
Practice Address - Country:US
Practice Address - Phone:765-318-6636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28223945C363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily