Provider Demographics
NPI:1174064562
Name:DEFRAIN, SUSAN REBEKAH (NP-C)
Entity type:Individual
Prefix:MRS
First Name:SUSAN
Middle Name:REBEKAH
Last Name:DEFRAIN
Suffix:
Gender:F
Credentials:NP-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:720 ESKENAZI AVE
Mailing Address - Street 2:SUITE F2-600
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5187
Mailing Address - Country:US
Mailing Address - Phone:317-880-6574
Mailing Address - Fax:317-962-2070
Practice Address - Street 1:720 ESKENAZI AVE
Practice Address - Street 2:SUITE F2-600
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5187
Practice Address - Country:US
Practice Address - Phone:317-880-6574
Practice Address - Fax:317-962-2070
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INAG02170207363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology