Healthcare Provider Details

I. General information

NPI: 1528781804
Provider Name (Legal Business Name): JORDAN REBEKAH MAXWELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JORDAN REBEKAH EARLES NONE, MAIDEN NAME

II. Dates (important events)

Enumeration Date: 09/22/2022
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

IV. Provider business mailing address

13225 N MERIDIAN ST
CARMEL IN
46032-5480
US

V. Phone/Fax

Practice location:
  • Phone: 317-228-7000
  • Fax: 317-228-2321
Mailing address:
  • Phone: 317-228-7000
  • Fax: 317-228-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013261A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71013261A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06221620
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: