Unknown Individual – Primary Care Nurse Practitioner, NPI 1104885151
Primary Care Nurse Practitioner
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for Unknown Individual
Prophetstown Aquatic Center, 5545, Swisher Road, West Lafayette, Tippecanoe County, Indiana, 47906, United States
LAFAYETTE, IN 479035545
Phone: (765) 448-8000
Type: Mailing
South 6th Street, Monticello, White County, Indiana, 47960, United States
MONTICELLO, IN 479608201
Phone: (765) 448-8000
Fax: (574) 583-9502
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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Medicare Enrollment & Revalidation
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No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
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No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 47903)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| NURSE PRACTITIONER | IN | 90670 | Pneumococcal vaccine for injection into muscle | 17 | 17 |
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