Provider Demographics
NPI:1831297985
Name:STIMLEY, REBECCA SUZANNE
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:SUZANNE
Last Name:STIMLEY
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 1:696 W NOWAK DR
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-8133
Mailing Address - Country:US
Mailing Address - Phone:219-363-1554
Mailing Address - Fax:
Practice Address - Street 1:696 W NOWAK DR
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-8133
Practice Address - Country:US
Practice Address - Phone:219-363-1554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021108A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist