MEDICARE: JEAN M LONERGAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	28144178A	IN

General Provider Information

NPI Number	:	1396085429
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN M LONERGAN RN

Provider Business Mailing Address
First Line	:	200 W 103RD ST STE 1300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1018
Country	:	US
Telephone Number	:	317-688-3690
Fax Number	:	317-688-3779

Provider Business Practice Location Address
First Line	:	200 W 103RD ST STE 1300
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46290-1018
Country	:	US
Telephone Number	:	317-688-3690
Fax Number	:	317-688-3779

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2013
Last Update Date	:	02/27/2013

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