Provider Demographics
NPI:1598041246
Name:GURNON, STEPHANIE B (LCGC)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:B
Last Name:GURNON
Suffix:
Gender:F
Credentials:LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 W WALNUT ST
Mailing Address - Street 2:IB 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5181
Mailing Address - Country:US
Mailing Address - Phone:317-274-3985
Mailing Address - Fax:317-278-0936
Practice Address - Street 1:975 W WALNUT ST
Practice Address - Street 2:IB 130
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5181
Practice Address - Country:US
Practice Address - Phone:317-274-3985
Practice Address - Fax:317-278-0936
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN74000024A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS