Provider Demographics
NPI:1215300892
Name:MANN, DENISE LYNN (NP)
Entity type:Individual
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First Name:DENISE
Middle Name:LYNN
Last Name:MANN
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Gender:F
Credentials:NP
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Mailing Address - Street 1:9011 N MERIDIAN ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5378
Mailing Address - Country:US
Mailing Address - Phone:317-564-2134
Mailing Address - Fax:317-574-4737
Practice Address - Street 1:8205 E 56TH ST
Practice Address - Street 2:SUITE 250
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46216-1003
Practice Address - Country:US
Practice Address - Phone:317-353-8985
Practice Address - Fax:317-353-2389
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2017-03-06
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Provider Licenses
StateLicense IDTaxonomies
IN71005987A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN796270009Medicare PIN