MEDICARE: ELIZABETH ANN HERNLY N.P.

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
1	363LF0000X	Family Nurse Practitioner	71000021A	IN

General Provider Information

NPI Number	:	1922080472
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN HERNLY N.P.

Provider Business Mailing Address
First Line	:	3266 N MERIDIAN ST
Second Line	:	SUITE 900
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-5846
Country	:	US
Telephone Number	:	317-924-8208
Fax Number	:	317-924-8348

Provider Business Practice Location Address
First Line	:	3266 N MERIDIAN ST
Second Line	:	SUITE 704
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46208-5846
Country	:	US
Telephone Number	:	317-924-8297
Fax Number	:	317-924-8239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	07/09/2007

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