Healthcare Provider Details

I. General information

NPI: 1255745709
Provider Name (Legal Business Name): NICHOLE LOUISE DRILLING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICHOLE LOUISE GRUNEISEN PA-C

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E. MAIN ST.
DANVILLE IN
46122
US

IV. Provider business mailing address

1100 SOUTHFIELD DR STE 1370
PLAINFIELD IN
46168-4300
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4676
  • Fax: 317-718-2476
Mailing address:
  • Phone: 317-837-5566
  • Fax: 317-837-5580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001658A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: