Provider Demographics
NPI:1235740085
Name:FUGATE, DANA LEIGH (FNP)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:LEIGH
Last Name:FUGATE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2445 N OLIVE CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PARAGON
Mailing Address - State:IN
Mailing Address - Zip Code:46166-9255
Mailing Address - Country:US
Mailing Address - Phone:317-989-8214
Mailing Address - Fax:
Practice Address - Street 1:727 MOON RD
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-8757
Practice Address - Country:US
Practice Address - Phone:317-839-2513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28175454A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily