Healthcare Provider Details

I. General information

NPI: 1346235553
Provider Name (Legal Business Name): NOEL COURTNEY PUTMAN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 11/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 N SHELBY ST
SALEM IN
47167-2304
US

IV. Provider business mailing address

8840 COMMERCE PARK PL STE E
INDIANAPOLIS IN
46268-3129
US

V. Phone/Fax

Practice location:
  • Phone: 812-883-5881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number28150634A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: