Healthcare Provider Details

I. General information

NPI: 1396109542
Provider Name (Legal Business Name): MELISSA MARIN A.P
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2016
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 N PENNSYLVANIA ST
INDIANAPOLIS IN
46240-2563
US

IV. Provider business mailing address

11521 FISHERS DR
FISHERS IN
46038-1860
US

V. Phone/Fax

Practice location:
  • Phone: 317-403-9189
  • Fax:
Mailing address:
  • Phone: 317-842-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: