Provider Demographics
NPI:1265849285
Name:ASFAW, FINOTE (NP)
Entity Type:Individual
Prefix:
First Name:FINOTE
Middle Name:
Last Name:ASFAW
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 SADDLE BARN EAST DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-1547
Mailing Address - Country:US
Mailing Address - Phone:317-529-2235
Mailing Address - Fax:862-298-0777
Practice Address - Street 1:5330 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-2147
Practice Address - Country:US
Practice Address - Phone:317-529-2235
Practice Address - Fax:862-298-0777
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004967A363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201243300Medicaid
IN715320011Medicare PIN