Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | AG09200205 | IN |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 71011253A | IN |
NPI | 1003487604 |
---|---|
Provider Name | Jennifer M Spors |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Carmel, IN 46032-4656 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2021 |
Last Update Date | 11/11/2021 |