Individual
JAELA MONE'A BASKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
9746 BRUDDY DR, FISHERS, IN 46038-8347
(317) 914-2124
Mailing address
9746 BRUDDY DR, FISHERS, IN 46038-8347
(317) 914-2124
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
—
—
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
KROAN1807606
ANTHEM BLUE CROSS BLUE SHIELD
—
Enumeration date
02/08/2019
Last updated
03/29/2019
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