MEDICARE: LEESA D FOLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	71004272A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053657387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEESA D FOLEY NP

Provider Business Mailing Address
First Line	:	1140 WEST MICHIGAN STREET
Second Line	:	STE 102 N
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-4959
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1140 W MICHIGAN ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5209
Country	:	US
Telephone Number	:	317-274-1019
Fax Number	:	317-278-4418

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2012
Last Update Date	:	09/14/2017

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