Provider Demographics
NPI:1033167531
Name:MOURA-SOUCHET, FRANCISCA (NP)
Entity Type:Individual
Prefix:
First Name:FRANCISCA
Middle Name:
Last Name:MOURA-SOUCHET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 WILLIAMS WAY E
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-8701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1728 WILLIAMS WAY E
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-8701
Practice Address - Country:US
Practice Address - Phone:765-617-8398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002095A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200806330Medicaid
INP01192266OtherRR MEDICARE PTAN
INM400046094Medicare PIN
INM400046064Medicare PIN
INM400046093Medicare PIN
INM400046062Medicare PIN
INM400046063Medicare PIN
IN200806330Medicaid
INP01192266OtherRR MEDICARE PTAN
INM400046092Medicare PIN