Healthcare Provider Details

I. General information

NPI: 1447176607
Provider Name (Legal Business Name): JESSICA JINELL LAUTERBACH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9310 S STATE ROAD 67
PENDLETON IN
46064-8536
US

IV. Provider business mailing address

10719 N BARNARD RD
PENDLETON IN
46064-9409
US

V. Phone/Fax

Practice location:
  • Phone: 765-778-3778
  • Fax:
Mailing address:
  • Phone: 317-612-7298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28271635A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: