Provider Demographics
NPI:1497461941
Name:GUPTILL, STEPHIE
Entity Type:Individual
Prefix:
First Name:STEPHIE
Middle Name:
Last Name:GUPTILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 LAFAYETTE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-1618
Mailing Address - Country:US
Mailing Address - Phone:317-266-9622
Mailing Address - Fax:
Practice Address - Street 1:5315 LAFAYETTE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-1618
Practice Address - Country:US
Practice Address - Phone:317-266-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator