Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 71004621A | IN |
NPI | 1013340066 |
---|---|
Provider Name | Mrs. Thomasina Marie Wrangham |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Anderson, IN 46016-4363 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2013 |
Last Update Date | 06/10/2015 |