Healthcare Provider Details

I. General information

NPI: 1114205572
Provider Name (Legal Business Name): LAURA ESPERANZA WORLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ESPERANZA PENA PA-C

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 RONALD REAGAN PKWY STE 148
AVON IN
46123-6913
US

IV. Provider business mailing address

8333 NAAB RD STE 250
INDIANAPOLIS IN
46260-1983
US

V. Phone/Fax

Practice location:
  • Phone: 317-396-1300
  • Fax: 317-217-2144
Mailing address:
  • Phone: 317-396-1300
  • Fax: 317-924-8472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number99048212A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001310A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: