Healthcare Provider Details

I. General information

NPI: 1942397559
Provider Name (Legal Business Name): JANE ANN MALKOFF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANE ANN KINSER MSN, RN, CS (ANP)

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W MORRIS ST SUITE 109
INDIANAPOLIS IN
46225-1492
US

IV. Provider business mailing address

226 YORKSHIRE CIR
NOBLESVILLE IN
46060-3867
US

V. Phone/Fax

Practice location:
  • Phone: 317-859-1090
  • Fax: 317-859-3322
Mailing address:
  • Phone: 317-979-3700
  • Fax: 317-774-0074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71000189A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: