MEDICARE: MARQUITTA ANTOINETTE TROTTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	27066069C	IN

General Provider Information

NPI Number	:	1114885100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUITTA ANTOINETTE TROTTER

Provider Business Mailing Address
First Line	:	5805 BYWOOD DR APT E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5805 BYWOOD DR APT E
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-4045
Country	:	US
Telephone Number	:	317-523-9026
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2026
Last Update Date	:	01/10/2026

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