Individual
LAURA KATHLEEN DAUGHERTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8075 N SHADELAND AVE STE 310, INDIANAPOLIS, IN 46250-2694
(317) 621-8000
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28201025A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
28201025A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300040788
—
IN
01
—
Q00237650
RAILROAD MEDICARE
IN
Enumeration date
05/29/2020
Last updated
04/01/2022
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