Healthcare Provider Details

I. General information

NPI: 1235655903
Provider Name (Legal Business Name): LAURA JANE KANNAIAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13085 TEGLER DR
NOBLESVILLE IN
46060-5417
US

IV. Provider business mailing address

13085 TEGLER DR
NOBLESVILLE IN
46060-5417
US

V. Phone/Fax

Practice location:
  • Phone: 317-770-7089
  • Fax:
Mailing address:
  • Phone: 317-770-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009826A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: