Provider Demographics
NPI:1245514470
Name:CRAGEN, DEBORAH JO
Entity type:Individual
Prefix:MISS
First Name:DEBORAH
Middle Name:JO
Last Name:CRAGEN
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:DEBORAH
Other - Middle Name:JO
Other - Last Name:CRAGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:STE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-887-7805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2010009450: ANCC363LA2200X
IN71004007A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01824420OtherRR PTAN
IN201074690Medicaid
IN715320009Medicare PIN
IN266180898Medicare PIN