Provider Demographics
NPI:1215097670
Name:MEYER, BERTHA GUNYON (RN, MA)
Entity type:Individual
Prefix:MS
First Name:BERTHA
Middle Name:GUNYON
Last Name:MEYER
Suffix:
Gender:F
Credentials:RN, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5054 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-6522
Mailing Address - Country:US
Mailing Address - Phone:317-247-8164
Mailing Address - Fax:317-962-2678
Practice Address - Street 1:1701 SENATE BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1239
Practice Address - Country:US
Practice Address - Phone:317-962-8191
Practice Address - Fax:317-962-2678
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN PROCESS101YP1600X
IN28065048A163WP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
Not Answered163WP1700XNursing Service ProvidersRegistered NursePerinatal