Provider Demographics
NPI:1659572717
Name:HARTWELL, CORA D (NP)
Entity Type:Individual
Prefix:
First Name:CORA
Middle Name:D
Last Name:HARTWELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10122 E 10TH STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-2664
Mailing Address - Country:US
Mailing Address - Phone:317-355-2200
Mailing Address - Fax:317-355-8750
Practice Address - Street 1:10122 E 10TH STREET
Practice Address - Street 2:SUITE 220
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-2664
Practice Address - Country:US
Practice Address - Phone:317-355-2200
Practice Address - Fax:317-355-8750
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000908A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200303520Medicaid
INP15826Medicare UPIN
IN263080DMedicare PIN
IN259670AMedicare PIN