Provider Demographics
NPI:1083190870
Name:STOCKING, MAIRE (APN)
Entity Type:Individual
Prefix:
First Name:MAIRE
Middle Name:
Last Name:STOCKING
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MS
Other - First Name:MAIRE
Other - Middle Name:
Other - Last Name:STOCKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FLOOD
Mailing Address - Street 1:3400 LAFAYETTE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1147
Mailing Address - Country:US
Mailing Address - Phone:317-291-7422
Mailing Address - Fax:
Practice Address - Street 1:3400 LAFAYETTE RD STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1147
Practice Address - Country:US
Practice Address - Phone:317-291-7422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-14
Last Update Date:2018-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008088A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71008088AOtherLICENSE