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NPI Code Detail

MEDICARE: KATHRYN PUZZELLA

MEDICARE: KATHRYN PUZZELLA
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
1363A00000XPhysician Assistant10005320AIN
2363A00000XPhysician Assistant085-010058IL
3390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1215658596
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN PUZZELLA
Provider Business Mailing Address
First Line : PO BOX 12815
Second Line :
City : BELFAST
State : ME
Zip : 04915-4019
Country : US
Telephone Number : 317-583-3444
Fax Number :
Provider Business Practice Location Address
First Line : 8414 NAAB RD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46260-1972
Country : US
Telephone Number : 317-338-7510
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2022
Last Update Date : 06/01/2026

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Directions to “ KATHRYN PUZZELLA ” Practice Location

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