MEDICARE: MASITA ISABEL PORAY NP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	71006787A	IN
2	363LG0600X	Gerontology Nurse Practitioner	71006787A	IN
3	363LP2300X	Primary Care Nurse Practitioner	71006787A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01824535	OTHER	IN	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386197770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MASITA ISABEL PORAY NP

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	STE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5435 E 16TH ST STE 500
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46218-4869
Country	:	US
Telephone Number	:	317-355-8280
Fax Number	:

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

Provider Enumeration Date	:	08/02/2016
Last Update Date	:	06/22/2021

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Directions to “ MASITA ISABEL PORAY NP” Practice Location

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