Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 02002245A | IN |
Y | 207Q00000X | Family Doctor | 02002245A | IN |
NPI | 1003933318 |
---|---|
Provider Name | Dr. Ann Marie Nelson |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-2213 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/03/2007 |
Last Update Date | 26/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201019710 | (05) | IN |