Healthcare Provider Details

I. General information

NPI: 1881989309
Provider Name (Legal Business Name): ANN ELIZABETH PURDY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN ELIZABETH WHELAN

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4676
  • Fax:
Mailing address:
  • Phone: 317-528-4800
  • Fax: 317-865-1479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10001281A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: