Healthcare Provider Details

I. General information

NPI: 1508781329
Provider Name (Legal Business Name): ANGELA DRAKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9550 W CONSTELLATION DR
PENDLETON IN
46064-7509
US

IV. Provider business mailing address

9550 W CONSTELLATION DR
PENDLETON IN
46064-7509
US

V. Phone/Fax

Practice location:
  • Phone: 317-750-7473
  • Fax:
Mailing address:
  • Phone: 317-750-7473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number2350846382
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: