Healthcare Provider Details

I. General information

NPI: 1205805959
Provider Name (Legal Business Name): JANIS E HORAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 12/06/2021
Certification Date: 12/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1473 SR 44
CONNERSVILLE IN
47331-8374
US

IV. Provider business mailing address

1908 N PARK RD
CONNERSVILLE IN
47331-2810
US

V. Phone/Fax

Practice location:
  • Phone: 765-825-0511
  • Fax: 765-827-1247
Mailing address:
  • Phone: 765-827-0876
  • Fax: 765-825-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71001128A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: