Sides, Staci Jeanne

Sides, Staci Jeanne is an individual health care provider with primary practice located at 400 N Mount Zion Rd , Lebanon IN 46052-9497. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as her primary health care specialty. Sides, Staci Jeanne can be contacted via phone (765) 335-0123.

Contact Information

Primary practice address
400 N Mount Zion Rd Lebanon IN 46052-9497
Phone: (765) 335-0123
Fax: (765) 335-0127
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 71006609A Indiana

Profile Details

NPI number 1023567823
LBN Legal business name Sides, Staci Jeanne
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2016
Last updated Jul 29th, 2021 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1023567823 NPPES
Indiana MEDICAID 201403450

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