Healthcare Provider Details

I. General information

NPI: 1588175921
Provider Name (Legal Business Name): DARLA JEAN HEALY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6330 E 75TH ST STE 174
INDIANAPOLIS IN
46250-2781
US

IV. Provider business mailing address

6330 E 75TH ST STE 174
INDIANAPOLIS IN
46250-2781
US

V. Phone/Fax

Practice location:
  • Phone: 317-296-7730
  • Fax: 317-545-1877
Mailing address:
  • Phone: 317-296-7730
  • Fax: 317-545-1877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number79000036A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: