Provider Demographics
NPI:1205179678
Name:DILL, LAUREN KRISTINA (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:KRISTINA
Last Name:DILL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9669 E 146TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-5005
Practice Address - Country:US
Practice Address - Phone:317-621-3434
Practice Address - Fax:317-621-3430
Is Sole Proprietor?:No
Enumeration Date:2013-04-03
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71004411A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201146880Medicaid
INP01678701OtherRR MEDICARE
INP01678701OtherRR MEDICARE