Healthcare Provider Details

I. General information

NPI: 1669897294
Provider Name (Legal Business Name): JACQUELINE AKERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 COLLINGWOOD DR
INDIANAPOLIS IN
46228-1920
US

IV. Provider business mailing address

1215 COLLINGWOOD DR
INDIANAPOLIS IN
46228-1920
US

V. Phone/Fax

Practice location:
  • Phone: 317-476-6313
  • Fax:
Mailing address:
  • Phone: 317-476-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number89333868397
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: