Individual
LARA JANE PESAVENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 567-2180
(317) 614-9655
Mailing address
PO BOX 7232, DEPT 118, INDIANAPOLIS, IN 46207-7232
(317) 567-2180
(317) 614-9655
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01061430
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200849010
—
IN
Enumeration date
10/12/2005
Last updated
07/19/2021
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