Healthcare Provider Details

I. General information

NPI: 1881237808
Provider Name (Legal Business Name): CHANDRA MARLIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 18TH ST STE 230
COLUMBUS IN
47201-5359
US

IV. Provider business mailing address

10303 SHELBYVILLE RD
INDIANAPOLIS IN
46259-9505
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-9261
  • Fax: 812-378-9518
Mailing address:
  • Phone: 709-035-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009512A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: