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Family >> Nurse Practitioner >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1467983619

Individual Registrant:
Gender: F
Not Sole Proprietor

Location and contact information for practice:
104 CONNIE AVE  SALEM, IN 47167-2305 US
Tel: 812-883-2696  Fax: --

Contact information for business:
10330 N MERIDIAN ST # 300  INDIANAPOLIS, IN 46290-1024 US
Tel: --  Fax: --

Registration Information:
NPI: 1467983619
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363LF0000XPhysician Assistants & Advanced Practice Nursing Providers
Nurse Practitioner

Legacy codes, insurance codes and state license numbers:



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