Healthcare Provider Details

I. General information

NPI: 1457910044
Provider Name (Legal Business Name): DANA MICHELE MARSH MSN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 S PARK RIDGE RD STE 101
BLOOMINGTON IN
47401-8589
US

IV. Provider business mailing address

3213 S EDEN DR
BLOOMINGTON IN
47401-8742
US

V. Phone/Fax

Practice location:
  • Phone: 812-331-8282
  • Fax:
Mailing address:
  • Phone: 317-474-4475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71008967A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: