Provider Demographics
NPI:1033449905
Name:WASHBURN, MONICA LEE (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:WASHBURN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1633 N CAPITOL AVE
Mailing Address - Street 2:STE 322
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-1261
Mailing Address - Country:US
Mailing Address - Phone:317-962-2929
Mailing Address - Fax:317-962-2070
Practice Address - Street 1:1633 N CAPITOL AVE
Practice Address - Street 2:STE 322
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-1261
Practice Address - Country:US
Practice Address - Phone:317-962-2929
Practice Address - Fax:317-962-2070
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002183A363LG0600X
IN71003183A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200975390Medicaid
INM400060391Medicare PIN