Individual
CARLY JANE JENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
550 UNIVERSITY BLVD STE 4601, INDIANAPOLIS, IN 46202-5149
(317) 944-4370
(317) 968-1254
Mailing address
147 EASTERN AVE, PLAINFIELD, IN 46168-1301
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
28210211A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71015489A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104324845
ANTHEM PTAN
IN
01
—
254330016
MEDICARE PTAN
IN
05
—
300095114
—
IN
Enumeration date
04/11/2024
Last updated
10/03/2024
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