Provider Demographics
NPI:1376218289
Name:STUMP, JENNIFER (NBC-HWC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:STUMP
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13111 AVON CROSS WAY
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7241
Mailing Address - Country:US
Mailing Address - Phone:317-690-4796
Mailing Address - Fax:
Practice Address - Street 1:13111 AVON CROSS WAY
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7241
Practice Address - Country:US
Practice Address - Phone:317-690-4796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date: