Healthcare Provider Details

I. General information

NPI: 1386020899
Provider Name (Legal Business Name): DANA MICHELE LARTY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2015
Last Update Date: 10/06/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 ESKENAZI AVE
INDIANAPOLIS IN
46202-5173
US

IV. Provider business mailing address

640 ESKENAZI AVE STE 100
INDIANAPOLIS IN
46202-5174
US

V. Phone/Fax

Practice location:
  • Phone: 317-221-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005640A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: