Individual
LORI R VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7250 CLEARVISTA DR, SUITE 100, INDIANAPOLIS, IN 46256-4692
(317) 621-5673
(317) 621-6040
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000650A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000781451
ANTHEM
IN
05
—
300005416
—
IN
01
—
P01192268
RR MEDICARE PTAN
IN
Enumeration date
06/26/2006
Last updated
11/27/2023
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