Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 01032796A | IN |
NPI | 1124001722 |
---|---|
Provider Name | Diane Weisman Healey |
First Address | Indianapolis, IN 46290-1024 |
Second Address | Indianapolis, IN 46260-5927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2005 |
Last Update Date | 24/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100345710 | (05) | IN |
B29564 | (02) |