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General NPI Number Information
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NPI Number | 1316293541
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Entity Type | Individual
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Provider Name | LAURA J KINNICK RN
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Gender | Female
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 08/29/2018
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Provider Practice Location Address
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Address Line | 355 W 16TH ST SUITE 5100
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City | INDIANAPOLIS
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State | IN
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Zip | 46202
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Country | US
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Telephone | 317-396-1300
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Fax | 317-924-8472
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | BLOOMINGTON
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State | IN
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Zip | 47402-1329
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Country | US
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Telephone |
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71004069A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28174769A
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License Number State | IN
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