Individual
JAYDE S. WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1030 W MICHIGAN ST FL 2, INDIANAPOLIS, IN 46202-5201
(317) 944-7241
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
28216495A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71009529A
IN
Other
Enumeration date
09/05/2019
Last updated
02/19/2025
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