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General NPI Number Information
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NPI Number | 1225391204
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Entity Type | Individual
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Provider Name | JENNIFER ELIA M.A.
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Gender | Female
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Dates
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Enumeration Date | 06/24/2012
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Last Update Date | 03/17/2023
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Provider Practice Location Address
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Address Line | 10080 E 121ST ST STE 112
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City | FISHERS
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State | IN
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Zip | 46037-4211
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Country | US
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Telephone | 317-813-1780
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Fax | 317-813-3012
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Provider Business Mailing Address
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Address Line | 10784 SWEET CREEK TRL
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City | FISHERS
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State | IN
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Zip | 46037-4098
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Country | US
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Telephone | 914-645-8862
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 656482
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License Number State | NY
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