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General NPI Number Information
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NPI Number | 1720707375
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Entity Type | Individual
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Provider Name | CARA MARIE PLAKE
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Gender | Female
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Dates
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Enumeration Date | 08/25/2022
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Last Update Date | 11/22/2024
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Provider Practice Location Address
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Address Line | 427 MAIN ST.
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City | LAFAYETTE
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State | IN
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Zip | 47901-1369
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Country | US
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Telephone | 765-413-2831
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Fax | 833-913-2401
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Provider Business Mailing Address
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Address Line | 427 MAIN ST STE 210
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City | LAFAYETTE
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State | IN
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Zip | 47901-1941
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Country | US
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Telephone | 765-404-8099
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 28229309A
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License Number State | IN
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