Provider Demographics
NPI:1659133023
Name:ROUX, STEPHANIE (CNM)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:ROUX
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 N SHADELAND AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2699
Mailing Address - Country:US
Mailing Address - Phone:317-437-3681
Mailing Address - Fax:855-279-1781
Practice Address - Street 1:7950 N SHADELAND AVE STE 350
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2699
Practice Address - Country:US
Practice Address - Phone:317-437-3681
Practice Address - Fax:855-279-1781
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN09000367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Single Specialty