Healthcare Provider Details

I. General information

NPI: 1134227481
Provider Name (Legal Business Name): JANE B PARKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N MERIDIAN ST
INDIANAPOLIS IN
46260-5381
US

IV. Provider business mailing address

6 HAWTHORNE CT
BATESVILLE IN
47006-9215
US

V. Phone/Fax

Practice location:
  • Phone: 574-268-9640
  • Fax:
Mailing address:
  • Phone: 812-933-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28083465
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: