MEDICARE: ALLYSE MCKENNA EMMEL

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1336986918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLYSE MCKENNA EMMEL

Provider Business Mailing Address
First Line	:	502 WOODRUFF PLACE MIDDLE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-1928
Country	:	US
Telephone Number	:	812-890-7853
Fax Number	:

Provider Business Practice Location Address
First Line	:	502 WOODRUFF PLACE MIDDLE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-1928
Country	:	US
Telephone Number	:	812-890-7853
Fax Number	:

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

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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Directions to “ ALLYSE MCKENNA EMMEL ” Practice Location

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