Basic Information
| Provider Information | |||||||||
| NPI: | 1962460394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FRASS | ||||||||
| FirstName: | NANCY | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSN ANP BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462372601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177821577 | ||||||||
| FaxNumber: | 3177805539 | ||||||||
| Practice Location | |||||||||
| Address1: | 5150 SHELBYVILLE RD | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462372601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3177821577 | ||||||||
| FaxNumber: | 3177805539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 03/27/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 71000964A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 200312430 | 05 | IN | MEDICAID |