Healthcare Provider Details

I. General information

NPI: 1376634238
Provider Name (Legal Business Name): MARY CAROLYN REARICK APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

14921 HAWTHORNE DRIVE
CARMEL IN
46033
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-2561
  • Fax: 317-988-4341
Mailing address:
  • Phone: 317-846-4850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71001297A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: