Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 28203846A | IN |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 71006276A | IN |
NPI | 1124476189 |
---|---|
Provider Name | Mrs. Abigail Lynn Bolls Standeford |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 18/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201410240 | (05) | IN |