=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992528525
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL NDUNGU
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2024
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11925 E 65TH ST STE 11925E65
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46236-3178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-835-3721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9161 COOPERS LN
-----------------------------------------------------
City | MCCORDSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46055-0319
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-835-3721
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 99123968A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------