Healthcare Provider Details

I. General information

NPI: 1841745577
Provider Name (Legal Business Name): MELISSA L HUMBURG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2016
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13400 N MERIDIAN ST
CARMEL IN
46032-7102
US

IV. Provider business mailing address

13400 N MERIDIAN ST STE 302
CARMEL IN
46032-7104
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: