Healthcare Provider Details

I. General information

NPI: 1801347000
Provider Name (Legal Business Name): LORI ENDICOTT-COOK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2016
Last Update Date: 08/19/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 PARKDALE PL SUITE D
INDIANAPOLIS IN
46254-5620
US

IV. Provider business mailing address

112 HOSPITAL LN STE 100
DANVILLE IN
46122-2600
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-7373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006761A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: