MRS. RAE MARIE STULL (NPI# 1053769133) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053769133 |
| Entity Type | Individual |
| Full Name | MRS. RAE MARIE STULL |
| Credential | NP |
| Practice Address |
2100 N Main St Ste 304 Crown Point IN 46307-1877 |
| Mailing Address |
Po Box 10299 Fort Wayne IN 46851-0299 |
| Practice Telephone | 5745461900 |
| Practice Fax Number | 5745461999 |
| Mailing Telephone | 5745461900 |
| Mailing Fax Number | 5745461999 |
| Enumeration Date | 2016-05-30 |
| Last Update Date | 2020-10-27 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 4704269369 | MI | Nursing Service Providers |
| N | 163W00000X | Registered Nurse | 28139816A | IN | Nursing Service Providers |
| N | 363LF0000X |
Nurse Practitioner Specialization: Family |
4704269369 | MI | Physician Assistants & Advanced Practice Nursing Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
71006752A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
2100 N MAIN ST STE 304 |
| City | CROWN POINT |
| State | IN |
| Zip Code | 46307-1877 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154308575 | Steven L Posar | Internal Medicine | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2005-12-28 |
| 1811596596 | Maureen R Reel | Social Worker | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-10-22 |
| 1528666484 | Debra L. Klich | Psychologist | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-10-13 |
| 1710584834 | Mya Yee Nandar | Nurse Practitioner | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-10-01 |
| 1437763018 | Lee Thomas Penn | Psychologist | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-09-01 |
| 1568075836 | Katherine Ann Frazier | Social Worker | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-08-26 |
| 1407474257 | William Lawrence Heard | Psychologist | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-07-08 |
| 1144853664 | Michelle Marie Schierberg | Nurse Practitioner | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-02-13 |
| 1417589292 | Whittney Thompson | Nurse Practitioner | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2020-02-10 |
| 1831733252 | Kelly Erin Suchar | Registered Nurse | 2100 N Main St Ste 304, Crown Point, IN 46307-1877 | 2019-10-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972117935 | Alimat O Biokoro | Home Health Aide | 1446 W 94th Ct., Crown Point, IN 46307 | 2020-09-06 |
| 1508489931 | Gentle Hearts Cardiovascular Institution LLC | Internal Medicine | 5221 W Lincoln Hwy, Suite 1a, Crown Point, IN 46307 | 2020-05-20 |
| 1659933646 | Darshak Joshi | Physical Therapist | 860 Stillwater Parkway, Crown Point, IN 46307 | 2019-07-01 |
| 1215592001 | Jamie Monday | Counselor | 1416 East Joliet St., Crown Point, IN 46307 | 2019-05-07 |
| 1790281152 | Tempus Labs Inc. | Clinical Medical Laboratory | 9800 Connecticut Drive, Suite A2-100, Crown Point, IN 46307 | 2018-04-04 |
| 1669991170 | Katie Lynn Eich | Counselor | 1308 N. Main St, Crown Point, IN 46307 | 2017-09-15 |
| 1053847251 | Nicole Bashan Lewis | Counselor | 1325 W 98th Ave, Crown Point, IN 46307 | 2017-05-08 |
| 1710433008 | Paul Alvin Clavecilla | Physical Therapist | 1099 South Main St., Apt. 314, Crown Point, IN 46307 | 2016-08-28 |
| 1851761365 | Cynthia Catherine Grass Black | Social Worker | 8592 Bell Lane, Crown Point, IN 46307 | 2015-09-28 |
| 1326437799 | Ameya Dorsatwar | Physical Therapist | 1516 North Main St, Crown Point, IN 46307 | 2015-01-22 |
| Find all providers in zip 46307 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174162754 | Katina A. Varner | Nurse Practitioner | 12445 Pennsylvania St, Crown Point, IN 46307-8072 | 2019-12-31 |
| 1255996336 | Elaine Diana Tsiakopoulos | Nurse Practitioner | 925 Lillian Russell Ct, Crown Point, IN 46307-7517 | 2019-05-05 |
| 1174039101 | Nickolas Emmanuel Mileos | Nurse Practitioner | 7630 E 112th Ave, Crown Point, IN 46307-5704 | 2017-12-28 |
| 1740792506 | Regina Springstead | Nurse Practitioner | 213 S Court St Ste B, Crown Point, IN 46307-3991 | 2017-11-01 |
| 1124436217 | Michelle Wathier | Nurse Practitioner | 2272 North Main Street, Minute Clinic, Crown Point, IN 46307 | 2014-08-01 |
| 1225218746 | Deborah Lynn Wickenden | Nurse Practitioner | 9150 East 109th Avenue, Crown Point, IN 46307 | 2007-11-13 |
| 1881724730 | Michelle Breunig | Nurse Practitioner | 180 W 128th Pl, Suite 1, Crown Point, IN 46307-7959 | 2007-03-07 |
| 1871634188 | Karen A Mannino | Nurse Practitioner | 10607 Randolph St, Ste C, Crown Point, IN 46307-7505 | 2007-02-09 |
| 1265400626 | Jill Carley | Nurse Practitioner | 9330 Broadway, Crown Point, IN 46307-8602 | 2006-03-10 |
| 1235107921 | Leslie Lembke | Nurse Practitioner | 9330 S. Broadway, Crown Point, IN 46307 | 2006-03-09 |
| Find all providers in CROWN POINT | ||||
| City | CROWN POINT |
| Zip Code | 46307 |
Please comment or provide details below to improve the information on MRS. RAE MARIE STULL.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.