| NPI | 1699514711 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAMES M PENTICUFF Practice Administrator 317-349-7680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine |
| 207QG0300X Family Medicine, Geriatric Medicine | |
| Enumeration Date | 2024-05-20 |
| Last Update Date | 2024-05-20 |