1841858115 NPI number — KATELYN JEAN LAKES MSN, RN, CNL, FNP-C

Table of content: KATELYN JEAN LAKES MSN, RN, CNL, FNP-C (NPI 1841858115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841858115 NPI number — KATELYN JEAN LAKES MSN, RN, CNL, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAKES
Provider First Name:
KATELYN
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CNL, FNP-C
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:
1841858115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 SOUTHFIELD DR STE 1370
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46168-4300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-837-5570
Provider Business Mailing Address Fax Number:
317-837-5580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
112 HOSPITAL LN STE 301
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46122-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-718-9028
Provider Business Practice Location Address Fax Number:
317-386-5468
Provider Enumeration Date:
06/03/2019

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: 163W00000X , with the licence number:  28229474A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 71009099A , 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)