Healthcare Provider Details

I. General information

NPI: 1508176892
Provider Name (Legal Business Name): AUDREY R ALCALA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUDREY R ALEXANDER

II. Dates (important events)

Enumeration Date: 10/20/2010
Last Update Date: 11/27/2023
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 S 19TH ST
ELWOOD IN
46036-2941
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 765-298-2800
  • Fax: 765-298-2820
Mailing address:
  • Phone: 765-298-5280
  • Fax: 765-552-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003418A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: