Individual
THERESE M CORDELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1800 N CAPITOL AVENUE, NP E-140, INDIANAPOLIS, IN 46202-1218
(317) 962-2894
(317) 963-5285
Mailing address
250 N SHADELAND AVE, STE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71002893A
IN
363LC0200X
Critical Care Medicine Nurse Practitioner
Primary
71002893
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201099640
—
IN
Enumeration date
08/26/2008
Last updated
07/03/2014
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