Provider Demographics
NPI:1598951030
Name:PONDER, CAROLYN M (RN)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:M
Last Name:PONDER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13450 N MERIDIAN ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1546
Mailing Address - Country:US
Mailing Address - Phone:317-582-7676
Mailing Address - Fax:
Practice Address - Street 1:13450 N MERIDIAN ST
Practice Address - Street 2:SUITE 160
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1546
Practice Address - Country:US
Practice Address - Phone:317-582-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28097573A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse