Provider Demographics
NPI:1205210861
Name:STEDMAN, JANA (PA-C)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:
Last Name:STEDMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3231
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-0231
Mailing Address - Country:US
Mailing Address - Phone:515-230-4062
Mailing Address - Fax:
Practice Address - Street 1:8032 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1330
Practice Address - Country:US
Practice Address - Phone:515-230-4062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005550363A00000X
IN10002344A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant