Healthcare Provider Details

I. General information

NPI: 1225531270
Provider Name (Legal Business Name): HARIMAYA POUDEL DHUNGANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1217 S RANGELINE RD
CARMEL IN
46032-2519
US

IV. Provider business mailing address

3806 W 86TH ST
INDIANAPOLIS IN
46268-1905
US

V. Phone/Fax

Practice location:
  • Phone: 161-542-5417
  • Fax: 317-574-4677
Mailing address:
  • Phone: 317-731-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71007842A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: