Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 02005981A | IN |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 02005981A | IN |
NPI | 1174011142 |
---|---|
Provider Name | Nicole Anne Slaten |
First Address | Indianapolis, IN 46260-1972 |
Second Address | Indianapolis, IN 46260-1972 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2018 |
Last Update Date | 08/12/2021 |