# NPI 1700755154

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- **Entity:** Individual
- **Status:** Inactive

## Provider details

- **NPI number:** 1700755154

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 164W00000X | Licensed Practical Nurse | 27073674A | IN | Yes |
| 376G00000X | Nursing Home Administrator | 14005683A | IN | — |

## Other

- **Enumeration date:** —
- **Last updated:** —