Healthcare Provider Details

I. General information

NPI: 1538228275
Provider Name (Legal Business Name): MARIETTA CRANEY CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10872 PINE BLUFF DR
FISHERS IN
46037-8929
US

IV. Provider business mailing address

6626 E 75TH STREET SUITE 500
INDIANAPOLIS IN
46250-2890
US

V. Phone/Fax

Practice location:
  • Phone: 317-585-8019
  • Fax:
Mailing address:
  • Phone: 317-621-7561
  • Fax: 317-355-6096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number71003770A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number33001799
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71003770A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28074744
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: