| NPI | 1235564188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRY PARRAN Credentialing Manager 317-213-5134 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2025-02-11 |