Provider Demographics
NPI:1376023739
Name:PURDUE, ELAINE NICOLE (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:ELAINE
Middle Name:NICOLE
Last Name:PURDUE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5216 E 71ST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3886
Mailing Address - Country:US
Mailing Address - Phone:317-507-4451
Mailing Address - Fax:
Practice Address - Street 1:8424 NAAB RD STE 2A
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1966
Practice Address - Country:US
Practice Address - Phone:317-415-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28211192A163WG0000X, 363LF0000X
IN71008220A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice