MEDICARE: LAURA NEVILLE FISHBURN RN

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	163W00000X	Registered Nurse	28217370A	IN

General Provider Information

NPI Number	:	1922823566
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA NEVILLE FISHBURN RN

Provider Business Mailing Address
First Line	:	8285 MOREL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-8107
Country	:	US
Telephone Number	:	317-965-1410
Fax Number	:

Provider Business Practice Location Address
First Line	:	8285 MOREL DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-8107
Country	:	US
Telephone Number	:	317-965-1410
Fax Number	:

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

Provider Enumeration Date	:	11/19/2024
Last Update Date	:	11/19/2024

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