MEDICARE: LORA FATHAUER M.S.N, N.P-C

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	363LA2200X	Adult Health Nurse Practitioner	71000213A	IN
2	363LF0000X	Family Nurse Practitioner	71000213A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	500030853	OTHER	IN	RR MEDICARE

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
3	SIHO	OTHER	IN	003707
4	CARESOURCE	OTHER	IN	820564758100
5	ANTHEM	OTHER	IN	000000317541

General Provider Information

NPI Number	:	1700853942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORA FATHAUER M.S.N, N.P-C

Provider Business Mailing Address
First Line	:	PO BOX 775383
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-5383
Country	:	US
Telephone Number	:	812-376-5315
Fax Number	:

Provider Business Practice Location Address
First Line	:	2326 18TH ST STE 210
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47201-5362
Country	:	US
Telephone Number	:	812-372-8680
Fax Number	:	812-372-9265

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

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	04/29/2025

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Directions to “ LORA FATHAUER M.S.N, N.P-C” Practice Location

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