Provider Demographics
NPI:1194745208
Name:BLANCHET, MARY P (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:P
Last Name:BLANCHET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:317-355-2700
Mailing Address - Fax:317-355-9445
Practice Address - Street 1:2920 N ARLINGTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46218-3362
Practice Address - Country:US
Practice Address - Phone:317-355-9431
Practice Address - Fax:317-355-9445
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000008A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000542851OtherANTHEM
INP01157037OtherMEDICARE RR
IN200063950Medicaid
INP01157037OtherMEDICARE RR
IN000000542851OtherANTHEM