MEDICARE: DONNA GENEVA DEMUNBRUN L.C.S.W.

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	171M00000X	Case Manager/Care Coordinator	34000657A	IN
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1578909024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA GENEVA DEMUNBRUN L.C.S.W.

Provider Business Mailing Address
First Line	:	1209 FINLEY AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-4378
Country	:	US
Telephone Number	:	317-220-8098
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 FINLEY AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46203-4378
Country	:	US
Telephone Number	:	317-220-8098
Fax Number	:

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

Provider Enumeration Date	:	05/10/2013
Last Update Date	:	05/10/2013

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Directions to “ DONNA GENEVA DEMUNBRUN L.C.S.W.” Practice Location

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