Provider Demographics
NPI:1912601691
Name:KAPOOR, MANDEEP (NP)
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:KAPOOR
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 1:11839 GEYSER CT
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-5497
Mailing Address - Country:US
Mailing Address - Phone:646-724-9694
Mailing Address - Fax:
Practice Address - Street 1:655 US 31 SOUTH
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-3061
Practice Address - Country:US
Practice Address - Phone:317-881-1655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-28
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013759A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily