Healthcare Provider Details

I. General information

NPI: 1720707375
Provider Name (Legal Business Name): CARA MARIE PLAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 MAIN ST.
LAFAYETTE IN
47901-1369
US

IV. Provider business mailing address

427 MAIN ST STE 210
LAFAYETTE IN
47901-1941
US

V. Phone/Fax

Practice location:
  • Phone: 765-413-2831
  • Fax: 833-913-2401
Mailing address:
  • Phone: 765-404-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number28229309A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: