Healthcare Provider Details

I. General information

NPI: 1598244725
Provider Name (Legal Business Name): LARA M NAANOUH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8091 TOWNSHIP LINE RD STE 206
INDIANAPOLIS IN
46260-2495
US

IV. Provider business mailing address

8091 TOWNSHIP LINE RD STE 206
INDIANAPOLIS IN
46260-2495
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-1000
  • Fax: 317-415-1010
Mailing address:
  • Phone: 317-415-1000
  • Fax: 317-415-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71008347A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: