Provider Demographics
NPI:1114482676
Name:TROYER, MARLA M (FNP)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:M
Last Name:TROYER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:M
Other - Last Name:HURFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:707 CEDAR ST STE 405
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2059
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:IN
Practice Address - Zip Code:46563-1861
Practice Address - Country:US
Practice Address - Phone:574-948-5100
Practice Address - Fax:574-335-0745
Is Sole Proprietor?:No
Enumeration Date:2019-02-08
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71008750A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102254257OtherANTHEM
IN300026662Medicaid