Healthcare Provider Details

I. General information

NPI: 1235060302
Provider Name (Legal Business Name): MARLA WHITE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3356 LAUREN DR
INDIANAPOLIS IN
46235-9141
US

IV. Provider business mailing address

3356 LAUREN DR
INDIANAPOLIS IN
46235-9141
US

V. Phone/Fax

Practice location:
  • Phone: 317-468-5901
  • Fax: 463-210-1113
Mailing address:
  • Phone: 317-468-5901
  • Fax: 463-210-1113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateIN
# 5
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: