Provider Demographics
NPI:1003153347
Name:WARD, PORSCHA DYANNE (NP)
Entity Type:Individual
Prefix:
First Name:PORSCHA
Middle Name:DYANNE
Last Name:WARD
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 W JEFFERSON ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:FRANKLIN
Mailing Address - State:IN
Mailing Address - Zip Code:46131-9121
Mailing Address - Country:US
Mailing Address - Phone:317-736-8474
Mailing Address - Fax:317-736-6040
Practice Address - Street 1:1300 W JEFFERSON ST
Practice Address - Street 2:SUITE C
Practice Address - City:FRANKLIN
Practice Address - State:IN
Practice Address - Zip Code:46131-9121
Practice Address - Country:US
Practice Address - Phone:317-736-8474
Practice Address - Fax:317-736-6040
Is Sole Proprietor?:No
Enumeration Date:2013-01-07
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004279A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201148550Medicaid
IN201148550Medicaid