Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 01082479A | IN |
Y | 111NI0900X | Internist | 01082479A | IN |
N | 207R00000X | Internist | 4301107550 | MI |
N | 111NI0900X | Internist | 4301107550 | MI |
NPI | 1003298555 |
---|---|
Provider Name | Courtney Myers |
First Address | Indianapolis, IN 46202 |
Second Address | Indianapolis, IN 46202-5187 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2015 |
Last Update Date | 08/04/2021 |