Provider Demographics
NPI:1720707375
Name:PLAKE, CARA MARIE
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:MARIE
Last Name:PLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 MAIN ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1941
Mailing Address - Country:US
Mailing Address - Phone:765-404-8099
Mailing Address - Fax:
Practice Address - Street 1:427 MAIN ST.
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1369
Practice Address - Country:US
Practice Address - Phone:765-413-2831
Practice Address - Fax:833-913-2401
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28229309A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28229309AOtherNURSING BOARD