Provider Demographics
NPI:1336986918
Name:EMMEL, ALLYSE MCKENNA
Entity type:Individual
Prefix:
First Name:ALLYSE
Middle Name:MCKENNA
Last Name:EMMEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 WOODRUFF PLACE MIDDLE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-1928
Mailing Address - Country:US
Mailing Address - Phone:812-890-7853
Mailing Address - Fax:
Practice Address - Street 1:502 WOODRUFF PLACE MIDDLE DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-1928
Practice Address - Country:US
Practice Address - Phone:812-890-7853
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program