Healthcare Provider Details

I. General information

NPI: 1639597974
Provider Name (Legal Business Name): LAURA TINDALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2014
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMUNITY PHYSICIAN NETWORK, HEART AND VASCULAR CARE 1402 E. COUNTY LINE RD., STE. 2400
INDIANAPOLIS IN
46227
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-621-8500
  • Fax: 317-621-8501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7100486A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: