Provider Demographics
NPI:1558661744
Name:CARDEN, DORIS M (NP)
Entity Type:Individual
Prefix:
First Name:DORIS
Middle Name:M
Last Name:CARDEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W OLD KEY DR
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IN
Mailing Address - Zip Code:46970-9057
Mailing Address - Country:US
Mailing Address - Phone:765-475-6963
Mailing Address - Fax:765-475-2833
Practice Address - Street 1:315 W OLD KEY DR
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IN
Practice Address - Zip Code:46970-9057
Practice Address - Country:US
Practice Address - Phone:765-475-6963
Practice Address - Fax:765-475-2833
Is Sole Proprietor?:No
Enumeration Date:2010-10-22
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003362A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201005370Medicaid
IN201005370Medicaid