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NPI Code Detail

MEDICARE: MILDRED SUE MCMANUS APRN C-FNP

MEDICARE: MILDRED SUE MCMANUS APRN C-FNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse PractitionerAP 04246LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128172656AOTHERINRN LICENSE
2AP04246OTHERLALA SBON APRN LIC #
3020489OTHERLALA STATE BD NRS ID #
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
571002372BOTHERINCSR
671002372AOTHERINNP REGISTRATION

General Provider Information

NPI Number : 1346244258
Entity Type Code : Individual
Provider Name (Legal Business Name) : MILDRED SUE MCMANUS APRN C-FNP
Provider Business Mailing Address
First Line : 252 N ODELL ST
Second Line :
City : BROWNSBURG
State : IN
Zip : 46112-2121
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-4273
Fax Number : 317-988-2171
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2005
Last Update Date : 03/07/2023

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