Most Relevant Information
Provider Data
| NPI Number: | 1003314246 |
| Provider Name: | STEPHANIE ANN CLOUSE NP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 71007750A |
Most Important Dates
| Enumeration Date: | 01/23/2018 |
| Last Updated: | 09/23/2020 |
Provider Practice Location
7910 W JEFFERSON BLVD STE 120
FORT WAYNE
IN
468044159
Practice Location Phone/Fax
| Phone: | 2604357612 |
| Fax: | 2604357672 |
Provider Mailing Location
6920 POINTE INVERNESS WAY STE 200
FORT WAYNE
IN
468047934
Provider Mailing Phone/Fax
| Phone: | 2604793514 |
| Fax: | 2604793520 |