1134755481 NPI number — KARA MONET JORDAN CNA,HHA

Table of content: KARA MONET JORDAN CNA,HHA (NPI 1134755481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134755481 NPI number — KARA MONET JORDAN CNA,HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN
Provider First Name:
KARA
Provider Middle Name:
MONET
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNA,HHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134755481
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4141 LAKE PARK BLVD APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46227-3975
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-680-4603
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4141 LAKE PARK BLVD APT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46227-3975
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-680-4603
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/19/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 374U00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 376K00000X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)