Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service | 20043217B | IN |
N | 103TH0100X | Health Service | 279-PY-PR-TEMP | MA |
NPI | 1629556535 |
---|---|
Provider Name | Jessicah Dawn Walker Herche |
First Address | Fishers, IN 46038-1213 |
Second Address | Indianapolis, IN 46240-3817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2018 |
Last Update Date | 06/05/2020 |