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General NPI Number Information
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NPI Number | 1669980280
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Entity Type | Individual
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Provider Name | CORIE L CONNOR A-GNP-C
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Gender | Female
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Dates
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Enumeration Date | 01/17/2018
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 8051 S EMERSON AVE STE 350
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City | INDIANAPOLIS
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State | IN
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Zip | 46237-8634
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Country | US
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Telephone | 317-859-1020
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Fax | 317-859-4040
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Provider Business Mailing Address
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Address Line | 6983 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 | 317-849-8350
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Fax | 317-576-6311
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28162979A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 71008080A
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License Number State | IN
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