Provider Demographics
NPI:1871900498
Name:ENGEL, STACEY MICHELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:STACEY
Middle Name:MICHELLE
Last Name:ENGEL
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 1:821 N STATE ROAD 135
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1314
Mailing Address - Country:US
Mailing Address - Phone:317-560-4300
Mailing Address - Fax:317-530-9084
Practice Address - Street 1:821 N STATE ROAD 135
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1314
Practice Address - Country:US
Practice Address - Phone:317-560-4300
Practice Address - Fax:317-530-9084
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2019-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28180686A363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01678705OtherRR PTAN
IN201253850Medicaid
IN266180643Medicare PIN