Basic Information
| Provider Information | |||||||||
| NPI: | 1447669213 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DRYE | ||||||||
| FirstName: | RACHAEL | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2827 SADDLE BARN EAST DR | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462141547 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175313038 | ||||||||
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| Practice Location | |||||||||
| Address1: | 234 E SOUTHERN AVE | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462252121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178825122 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 12/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 09000335A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife | 363LP0200X | 71005011A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | DEA | 01 | MD5012719 | OTHER |