Provider Demographics
NPI:1346908761
Name:GANTZ FINGERHUT, RACHEL KATHLEEN
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:KATHLEEN
Last Name:GANTZ FINGERHUT
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 1:10305 TAMMER DR
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-9741
Mailing Address - Country:US
Mailing Address - Phone:773-405-1811
Mailing Address - Fax:
Practice Address - Street 1:6940 MICHIGAN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2800
Practice Address - Country:US
Practice Address - Phone:317-266-2901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28229995A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner