Healthcare Provider Details

I. General information

NPI: 1265764138
Provider Name (Legal Business Name): MARCIE ANN BRYANT RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2010
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 W 38TH ST
INDIANAPOLIS IN
46228-3202
US

IV. Provider business mailing address

890 PREAKNESS DR
GREENWOOD IN
46143-8173
US

V. Phone/Fax

Practice location:
  • Phone: 317-328-0671
  • Fax:
Mailing address:
  • Phone: 317-408-4366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number09000156A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: