Healthcare Provider Details

I. General information

NPI: 1942071915
Provider Name (Legal Business Name): PRORENATA DIAGNOSTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2024
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1248 HAMILTON DR
GREENWOOD IN
46143-5530
US

IV. Provider business mailing address

8063 MADISON AVE PMB 571
INDIANAPOLIS IN
46227
US

V. Phone/Fax

Practice location:
  • Phone: 800-396-4291
  • Fax:
Mailing address:
  • Phone: 800-396-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TALEIA POWELL
Title or Position: OWNER
Credential:
Phone: 800-396-4291