Healthcare Provider Details

I. General information

NPI: 1598951030
Provider Name (Legal Business Name): CAROLYN M. PONDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2007
Last Update Date: 09/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13450 N MERIDIAN ST SUITE 160
CARMEL IN
46032-1546
US

IV. Provider business mailing address

13450 N MERIDIAN ST SUITE 160
CARMEL IN
46032-1546
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-7676
  • Fax:
Mailing address:
  • Phone: 317-582-7676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28097573A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: