Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 71007939A | IN |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 71007939A | IN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 71007939A | IN |
N | 363LP2300X | Nurse Practitioner - Primary Care | 209013677 | IL |
NPI | 1164887618 |
---|---|
Provider Name | Deborah A Masiak |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2015 |
Last Update Date | 20/06/2018 |