Healthcare Provider Details

I. General information

NPI: 1285093120
Provider Name (Legal Business Name): ANGELICA CHESTNUT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2016
Last Update Date: 03/20/2021
Certification Date: 03/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 HARCOURT RD STE 205
INDIANAPOLIS IN
46260-2082
US

IV. Provider business mailing address

8301 HARCOURT RD STE 205
INDIANAPOLIS IN
46260-2082
US

V. Phone/Fax

Practice location:
  • Phone: 317-228-3393
  • Fax: 317-228-3397
Mailing address:
  • Phone: 317-228-3393
  • Fax: 317-228-3397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006574A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: