Provider Demographics
NPI:1538441183
Name:KLEIN, EMILY MICHELLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:MICHELLE
Last Name:KLEIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:MICHELLE
Other - Last Name:GIORDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47547-1028
Mailing Address - Country:US
Mailing Address - Phone:812-996-5781
Mailing Address - Fax:812-996-0150
Practice Address - Street 1:721 W 13TH ST
Practice Address - Street 2:SUITE 325
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-1855
Practice Address - Country:US
Practice Address - Phone:812-996-5781
Practice Address - Fax:812-996-0150
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003684A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201035170Medicaid
INM400056246Medicare PIN