Connie S Carunchia Professional Corporation

Key facts

NPI

1487948816

Entity type

Organization (NPI type 2)

Primary specialty

Gerontology Nurse Practitioner 363LG0600X

License

55000068A (IN)

Legal business name

CONNIE S CARUNCHIA PROFESSIONAL CORPORATION

Practice address

5900 E 500 N
Kendallville, IN 46755-9349

Phone

(260) 349-8185

Fax

(888) 347-0088

NPI assigned

Jun 2, 2011

Organization subpart

No

Authorized official

Name

Connie S. Cole, NP-C

Title

President/Owner

Phone

(260) 349-8185

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

Other names

• Connie S. Herron, PC Former legal business name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 4, 2014.

{
    "created_epoch": "1306972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407110400000",
    "number": "1487948816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 E 500 N",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467559349",
            "telephone_number": "260-349-8185",
            "fax_number": "888-347-0088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 E 500 N",
            "city": "KENDALLVILLE",
            "state": "IN",
            "postal_code": "467559349",
            "telephone_number": "260-349-8185",
            "fax_number": "888-347-0088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNIE S CARUNCHIA PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-02",
        "last_updated": "2014-08-04",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "260-349-8185",
        "authorized_official_credential": "NP-C"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "IN",
            "license": "55000068A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201023750A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "DS6979",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Connie S. Herron, PC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Kendallville, IN

• Vincent J Coda, DPM
• Connie S. Cole, NP-C
• Community Hospital of Noble County, Inc.
• Community Hospital of Noble County, Inc.
• Kassidy Conley, RBT
• Patrick John Connolly, PHD
• Kaitlin Beth Cowan, PH.D.
• Michael Thomas Cox, DC
• Joseph F Csincsak, L.C.S.W.
• Dianne Elizabeth Daugherty, ACSW, LCSW

All providers in Kendallville, IN · Gerontology Nurse Practitioner in Indiana