Healthcare Provider Details

I. General information

NPI: 1326956780
Provider Name (Legal Business Name): CORNELUGE HOUNNOU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2346 S LYNHURST DR STE 507
INDIANAPOLIS IN
46241-8603
US

IV. Provider business mailing address

2346 S LYNHURST DR STE 507
INDIANAPOLIS IN
46241-8603
US

V. Phone/Fax

Practice location:
  • Phone: 317-985-2743
  • Fax:
Mailing address:
  • Phone: 317-985-2743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28271505A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: