Provider Demographics
NPI:1003168667
Name:MCNAMARA, STEPHANIE LYNNE (NP-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNNE
Last Name:MCNAMARA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:SCHMUHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1033 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:IN
Mailing Address - Zip Code:46567-1017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1033 N INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:IN
Practice Address - Zip Code:46567-1017
Practice Address - Country:US
Practice Address - Phone:574-457-5701
Practice Address - Fax:574-457-5609
Is Sole Proprietor?:No
Enumeration Date:2012-10-08
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004177A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201114700Medicaid
IN201114700Medicaid