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NPI Code Detail

MEDICARE: ANNA MARIE AVELINE NP

MEDICARE:   ANNA MARIE AVELINE  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
1163W00000XRegistered Nurse28083833AIN
2363L00000XNurse Practitioner71001885AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00220524OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3000000491145OTHERINANTHEM BCBC

General Provider Information

NPI Number : 1548259625
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA MARIE AVELINE NP
Provider Business Mailing Address
First Line : PO BOX 746720
Second Line :
City : ATLANTA
State : GA
Zip : 30374-6720
Country : US
Telephone Number : 312-733-9730
Fax Number : 773-866-8014
Provider Business Practice Location Address
First Line : 4200 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1534
Country : US
Telephone Number : 317-991-7600
Fax Number : 317-215-7030
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2005
Last Update Date : 11/18/2022

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