Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224P00000X | Prosthetist | CI21700032 | IN |
NPI | 1003427212 |
---|---|
Provider Name | Betria Mccloud |
First Address | Indianapolis, IN 46226-5740 |
Second Address | Carmel, IN 46033-7714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2020 |
Last Update Date | 11/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
85-0824374 | IRS (01) |