Healthcare Provider Details

I. General information

NPI: 1174366314
Provider Name (Legal Business Name): NICHOLE MORTON MHA,BSN,RN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2024
Last Update Date: 06/17/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8530 TOWNSHIP LINE RD
INDIANAPOLIS IN
46260
US

IV. Provider business mailing address

1187 PINEWOOD DR
PLAINFIELD IN
46168-2487
US

V. Phone/Fax

Practice location:
  • Phone: 463-999-9045
  • Fax:
Mailing address:
  • Phone: 812-240-3526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28183233A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: