MEDICARE: LOICE MUKONA

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	28140253A	IN
2	363LF0000X	Family Nurse Practitioner	71003823	IN
3	363L00000X	Nurse Practitioner	71003823A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427321033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOICE MUKONA

Provider Business Mailing Address
First Line	:	1801 RED PHISTER DR
Second Line	:
City	:	AVON
State	:	IN
Zip	:	46123-7172
Country	:	US
Telephone Number	:	317-272-1383
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 N POST RD STE 4
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-4225
Country	:	US
Telephone Number	:	317-405-8833
Fax Number	:	317-672-2398

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

Provider Enumeration Date	:	02/13/2012
Last Update Date	:	05/05/2022

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Directions to “ LOICE MUKONA ” Practice Location

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