Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 71006756A | IN |
NPI | 1003350596 |
---|---|
Provider Name | Audra Abel |
First Address | Georgetown, IN 47122-9291 |
Second Address | Georgetown, IN 47122-9291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2016 |
Last Update Date | 19/12/2016 |