Healthcare Provider Details

I. General information

NPI: 1114224557
Provider Name (Legal Business Name): LOANNE M. FAULSTICH-FOX ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2011
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13430 N MERIDIAN ST STE 173
CARMEL IN
46032-1449
US

IV. Provider business mailing address

13430 N MERIDIAN ST STE 173
CARMEL IN
46032-1449
US

V. Phone/Fax

Practice location:
  • Phone: 317-582-7066
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71003541A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: