Provider Demographics
NPI:1114511466
Name:MIRCHANDANI POPP, JADE SIMONE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:SIMONE
Last Name:MIRCHANDANI POPP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3519 ALEXIS DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-0100
Mailing Address - Country:US
Mailing Address - Phone:502-758-2512
Mailing Address - Fax:
Practice Address - Street 1:3519 ALEXIS DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-0100
Practice Address - Country:US
Practice Address - Phone:502-758-2512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28230487A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse