Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 71008313A | IN |
NPI | 1003392424 |
---|---|
Provider Name | Emily Kelly Koffel |
First Address | Indianapolis, IN 46260-1316 |
Second Address | Indianapolis, IN 46260-2279 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2018 |
Last Update Date | 17/09/2018 |