Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71003183A | IN |
N | 363LG0600X | Nurse Practitioner - Gerontology | 71002183A | IN |
NPI | 1033449905 |
---|---|
Provider Name | Monica Lee Washburn |
First Address | Indianapolis, IN 46202-1261 |
Second Address | Indianapolis, IN 46202-1261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2009 |
Last Update Date | 24/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200975390 | (05) | IN |