Healthcare Provider Details

I. General information

NPI: 1427817352
Provider Name (Legal Business Name): MARIE E MENCHHOFER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 GASLIGHT DR STE 1
VERSAILLES IN
47042-9471
US

IV. Provider business mailing address

202 GASLIGHT DR STE 1
VERSAILLES IN
47042-9471
US

V. Phone/Fax

Practice location:
  • Phone: 812-609-2030
  • Fax: 949-850-7921
Mailing address:
  • Phone: 812-609-2030
  • Fax: 949-850-7921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28187879A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: