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 |