Provider Demographics
NPI:1245460823
Name:STOECKEL, NINA (PH D)
Entity type:Individual
Prefix:MRS
First Name:NINA
Middle Name:
Last Name:STOECKEL
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15834 ARBOR CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-7858
Mailing Address - Country:US
Mailing Address - Phone:315-395-3807
Mailing Address - Fax:
Practice Address - Street 1:6910 NORTH MAIN STREET
Practice Address - Street 2:BUILDING 13, SUITE C
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530
Practice Address - Country:US
Practice Address - Phone:574-216-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2023-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019762103TC0700X
IN20043257103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical