Healthcare Provider Details

I. General information

NPI: 1457768905
Provider Name (Legal Business Name): DANIELLE FORD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2014
Last Update Date: 07/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

720 ESKENAZI AVE
INDIANAPOLIS IN
46202-5166
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-9189
  • Fax: 317-880-0415
Mailing address:
  • Phone: 317-880-9189
  • Fax: 317-880-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number28191190A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: