Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71007298A | IN |
NPI | 1023531688 |
---|---|
Provider Name | Megan Burton |
First Address | Indianapolis, IN 46234-7677 |
Second Address | Avon, IN 46123-8923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2017 |
Last Update Date | 17/03/2018 |