Healthcare Provider Details

I. General information

NPI: 1336418003
Provider Name (Legal Business Name): DENISE M RODY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DENISE M LEGGE

II. Dates (important events)

Enumeration Date: 12/23/2011
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 WEST CARMEL DR. STE. 101
CARMEL IN
46032-5875
US

IV. Provider business mailing address

755 WEST CARMEL DR. STE. 101
CARMEL IN
46032-5875
US

V. Phone/Fax

Practice location:
  • Phone: 317-846-2396
  • Fax: 317-846-1699
Mailing address:
  • Phone: 317-846-2396
  • Fax: 317-846-1699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71000326A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: