Healthcare Provider Details

I. General information

NPI: 1164694345
Provider Name (Legal Business Name): CARMEN MERRIWEATHER MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2008
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7007 GRAHAM ROAD SUITE 215
INDIANAPOLIS IN
46220-3235
US

IV. Provider business mailing address

7007 GRAHAM ROAD SUITE 215
INDIANAPOLIS IN
46220-0071
US

V. Phone/Fax

Practice location:
  • Phone: 317-820-3565
  • Fax: 317-375-6470
Mailing address:
  • Phone: 317-820-3565
  • Fax: 317-375-6470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number48-01-04-05216
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: