Healthcare Provider Details

I. General information

NPI: 1336231133
Provider Name (Legal Business Name): THERESA KAY MENNER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRY KAY MENNER

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8244 E. US 36 STE. 1100, HENDRICKS REGIONAL HEALTH IMMEDIATE CARE
AVON IN
46123-9627
US

IV. Provider business mailing address

34 W 59TH ST
INDIANAPOLIS IN
46208-1513
US

V. Phone/Fax

Practice location:
  • Phone: 317-272-7500
  • Fax: 317-272-7515
Mailing address:
  • Phone: 317-257-2636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number70000199A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number70000199A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: