Healthcare Provider Details

I. General information

NPI: 1285878918
Provider Name (Legal Business Name): MARY ANN NORRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2009
Last Update Date: 06/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4199 GATEWAY BLVD
NEWBURGH IN
47630-8940
US

IV. Provider business mailing address

4199 GATEWAY BLVD
NEWBURGH IN
47630-8940
US

V. Phone/Fax

Practice location:
  • Phone: 812-842-4200
  • Fax: 812-842-4219
Mailing address:
  • Phone: 812-842-4200
  • Fax: 812-842-4219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number71002012A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: