Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 71008765A | IN |
NPI | 1013473297 |
---|---|
Provider Name | Patricia Justine Irvin |
First Address | Indianapolis, IN 46250-2890 |
Second Address | Greenwood, IN 46143-2401 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2019 |
Last Update Date | 29/10/2021 |