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General NPI Number Information
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NPI Number | 1487948816
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Entity Type | Organization
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Legal Business Name | CONNIE S CARUNCHIA PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 08/04/2014
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Provider Practice Location Address
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Address Line | 5900 E 500 N
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City | KENDALLVILLE
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State | IN
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Zip | 46755-9349
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Country | US
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Telephone | 260-349-8185
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Fax | 888-347-0088
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Provider Business Mailing Address
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Address Line | 5900 E 500 N
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City | KENDALLVILLE
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State | IN
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Zip | 46755-9349
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Country | US
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Telephone | 260-349-8185
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Fax | 888-347-0088
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | CONNIE S. COLE
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Credential | NP-C
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Telephone | 260-349-8185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 55000068A
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License Number State | IN
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