Healthcare Provider Details

I. General information

NPI: 1295429389
Provider Name (Legal Business Name): NICHOLE BARRY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 11/02/2023
Certification Date: 11/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8051 S EMERSON AVE STE 365
INDIANAPOLIS IN
46237-0011
US

IV. Provider business mailing address

2650 WARRENVILLE RD STE 280
DOWNERS GROVE IL
60515-2075
US

V. Phone/Fax

Practice location:
  • Phone: 317-851-2331
  • Fax:
Mailing address:
  • Phone: 630-324-7920
  • Fax: 630-324-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28276151A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013964A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: