Healthcare Provider Details

I. General information

NPI: 1497744312
Provider Name (Legal Business Name): CONNIE SUE TOWNSEND FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1466 W OAK ST
ZIONSVILLE IN
46077-1800
US

IV. Provider business mailing address

1214 CHENOWETH LN
W LAFAYETTE IN
47906-8527
US

V. Phone/Fax

Practice location:
  • Phone: 317-873-6438
  • Fax:
Mailing address:
  • Phone: 765-583-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000162A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: