Healthcare Provider Details

I. General information

NPI: 1255893723
Provider Name (Legal Business Name): LIARA ROE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 E 138TH ST BLDG A
FISHERS IN
46037-0087
US

IV. Provider business mailing address

679 E COUNTY LINE RD
GREENWOOD IN
46143-1049
US

V. Phone/Fax

Practice location:
  • Phone: 317-890-2000
  • Fax: 317-813-1667
Mailing address:
  • Phone: 317-890-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28190944A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: