Healthcare Provider Details

I. General information

NPI: 1518509140
Provider Name (Legal Business Name): RASHIDA AKILAH DODSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 02/12/2021
Certification Date: 01/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S RANGELINE RD
CARMEL IN
46032-2519
US

IV. Provider business mailing address

1217 S RANGELINE RD
CARMEL IN
46032-2519
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-4818
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number28170552A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71010844A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: