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General NPI Number Information
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NPI Number | 1548259625
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Entity Type | Individual
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Provider Name | ANNA MARIE AVELINE NP
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Gender | Female
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 11/18/2022
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Provider Practice Location Address
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Address Line | 4200 S EAST ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-1534
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Country | US
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Telephone | 317-991-7600
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Fax | 317-215-7030
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Provider Business Mailing Address
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Address Line | PO BOX 746720
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City | ATLANTA
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State | GA
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Zip | 30374-6720
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Country | US
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Telephone | 312-733-9730
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Fax | 773-866-8014
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 28083833A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 71001885A
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License Number State | IN
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