Healthcare Provider Details

I. General information

NPI: 1679755482
Provider Name (Legal Business Name): KATRINA LOU JAHN CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATRINA LOU NESTEL CNS

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST PSYCHIATRY AMBULATORY CARE CLINIC
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

2013 E 65TH ST
INDIANAPOLIS IN
46220-2134
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2000
  • Fax: 317-988-2884
Mailing address:
  • Phone: 317-254-0125
  • Fax: 317-988-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28134167A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number2007009969
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: