Provider Demographics
NPI:1063414662
Name:MCELROY, PATRICIA L (NP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:MCELROY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:10701 ALLIANCE DR STE A
Practice Address - Street 2:
Practice Address - City:CAMBY
Practice Address - State:IN
Practice Address - Zip Code:46113-8837
Practice Address - Country:US
Practice Address - Phone:317-856-7083
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2021-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000662A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1033110564OtherGROUP NPI NUMBER
IN200092590Medicaid
IN200218480Medicaid
IN200092590Medicaid
IN1033110564OtherGROUP NPI NUMBER
IN563420QMedicare ID - Type UnspecifiedM-CARE INDIVIDUAL NUMBER