Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71002121A | IN |
NPI | 1023122835 |
---|---|
Provider Name | Norma Jean Bangel |
First Address | Mooresville, IN 46158-1907 |
Second Address | Indianapolis, IN 46202-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |