Provider Demographics
NPI:1215019401
Name:KAUFFMAN, CAROL JUNE (APRN)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JUNE
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6021 KENTUCKY AVENUE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221
Mailing Address - Country:US
Mailing Address - Phone:317-856-5565
Mailing Address - Fax:317-856-1202
Practice Address - Street 1:6021 KENTUCKY AVENUE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221
Practice Address - Country:US
Practice Address - Phone:317-856-5565
Practice Address - Fax:317-856-1202
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000386020OtherBLUE CROSS BLUE SHIELD
P09225Medicare UPIN
IN233820BMedicare ID - Type Unspecified