Healthcare Provider Details

I. General information

NPI: 1053241026
Provider Name (Legal Business Name): CHANDA JEFFERSON NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7164 GRAHAM RD STE 120C
INDIANAPOLIS IN
46250-2675
US

IV. Provider business mailing address

7164 GRAHAM RD STE 120C
INDIANAPOLIS IN
46250-2675
US

V. Phone/Fax

Practice location:
  • Phone: 317-529-5329
  • Fax:
Mailing address:
  • Phone: 317-529-5329
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number26-018530
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: