Healthcare Provider Details

I. General information

NPI: 1780360230
Provider Name (Legal Business Name): JORDAN GARDNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

590 PIT RD
BROWNSBURG IN
46112-7830
US

IV. Provider business mailing address

590 PIT RD
BROWNSBURG IN
46112-7830
US

V. Phone/Fax

Practice location:
  • Phone: 317-456-1100
  • Fax: 317-334-8868
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202325711
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71015547A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: