Provider Demographics
NPI:1821540444
Name:DIDYK-HORINE, STEPHANIE A (NP)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:A
Last Name:DIDYK-HORINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N SENATE BLVD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1228
Mailing Address - Country:US
Mailing Address - Phone:317-962-0500
Mailing Address - Fax:317-962-0501
Practice Address - Street 1:1801 N SENATE BLVD
Practice Address - Street 2:SUITE 4000
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1228
Practice Address - Country:US
Practice Address - Phone:317-962-0500
Practice Address - Fax:317-962-0501
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006660A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201405470Medicaid
IN201405470Medicaid
IN183380041Medicare PIN