Healthcare Provider Details

I. General information

NPI: 1538428875
Provider Name (Legal Business Name): ERICA HENDRESS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2012
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 N DAN JONES RD STE 150
PLAINFIELD IN
46168-2848
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-7328
  • Fax: 317-781-7216
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28186432A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004037A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier71004037A
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerAPN PRESCRIPTIVE AUTHORITY
# 2
Identifier28186432A
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerRN
# 3
Identifier71004037B
Identifier TypeOTHER
Identifier StateIN
Identifier IssuerCSR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: