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NPI Code Detail

MEDICARE: MARY BRAND FNP-BC

MEDICARE: MARY BRAND FNP-BC
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
1363LF0000XFamily Nurse Practitioner71002528AIN

General Provider Information

NPI Number : 1891066783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY BRAND FNP-BC
Provider Business Mailing Address
First Line : 3400 LAFAYETTE RD, SUITE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46222
Country : US
Telephone Number : 317-291-7422
Fax Number : 317-291-4912
Provider Business Practice Location Address
First Line : 3400 LAFAYETTE RD STE 200
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46222-1147
Country : US
Telephone Number : 317-291-7422
Fax Number : 317-291-4912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2012
Last Update Date : 05/25/2012

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Directions to “ MARY BRAND FNP-BC” Practice Location

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