MEDICARE: CATRINA LATRESE FRY RRT, AS, (DONA)

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	374J00000X	Doula

General Provider Information

NPI Number	:	1609104298
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATRINA LATRESE FRY RRT, AS, (DONA)

Provider Business Mailing Address
First Line	:	5615 W VERMONT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-8702
Country	:	US
Telephone Number	:	317-698-2030
Fax Number	:

Provider Business Practice Location Address
First Line	:	5615 W VERMONT ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-8702
Country	:	US
Telephone Number	:	317-698-2030
Fax Number	:

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

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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