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General NPI Number Information
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NPI Number | 1174839260
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Entity Type | Individual
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Provider Name | JEROME JOY R.N.
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Gender | Male
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Dates
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Enumeration Date | 08/26/2010
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Last Update Date | 08/26/2010
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Provider Practice Location Address
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Address Line | 6923 HILLSDALE CT
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City | INDIANAPOLIS
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State | IN
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Zip | 46250-2054
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Country | US
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Telephone | 765-987-8171
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 94 215 S. PEARL ST.
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City | SPICELAND
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State | IN
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Zip | 47385-0094
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Country | US
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Telephone | 765-987-8171
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 28159971A
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License Number State | IN
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