Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71004279A | IN |
NPI | 1003153347 |
---|---|
Provider Name | Porscha Dyanne Ward |
First Address | Franklin, IN 46131-9121 |
Second Address | Franklin, IN 46131-9121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/01/2013 |
Last Update Date | 21/10/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201148550 | (05) | IN |