Provider Demographics
NPI:1578815833
Name:DECKER-RADFORD, JANET ANN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:ANN
Last Name:DECKER-RADFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4317 STRAWFLOWER DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-6925
Mailing Address - Country:US
Mailing Address - Phone:317-489-1648
Mailing Address - Fax:317-791-6738
Practice Address - Street 1:4317 STRAWFLOWER DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-6925
Practice Address - Country:US
Practice Address - Phone:317-489-1648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003744A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS71003744AOtherNPI ENUMERATOR