Provider Demographics
NPI:1649725151
Name:ALLAN, STUART
Entity type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:ALLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:STUART
Other - Middle Name:A
Other - Last Name:ALLAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FC-BC
Mailing Address - Street 1:4501 BLAIR LN
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-9164
Mailing Address - Country:US
Mailing Address - Phone:219-286-3494
Mailing Address - Fax:
Practice Address - Street 1:801 MACARTHUR BLVD STE 404
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2919
Practice Address - Country:US
Practice Address - Phone:219-836-2995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28182561A163W00000X
IN71006523A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse