Healthcare Provider Details

I. General information

NPI: 1316997547
Provider Name (Legal Business Name): MARY J EOFF NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 UNIVERSITY BLVD STE. 2115
INDIANAPOLIS IN
46202-5149
US

IV. Provider business mailing address

1120 SOUTH DR
INDIANAPOLIS IN
46202-5135
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-2891
  • Fax: 317-567-2191
Mailing address:
  • Phone: 317-274-0273
  • Fax: 317-567-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0200X
TaxonomyPediatric Clinical Nurse Specialist
License Number71000967
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: