Provider Demographics
NPI:1124232764
Name:HOWARD, ADRIENNE M (FNP)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:M
Last Name:HOWARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 W SPENCER AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-3415
Mailing Address - Country:US
Mailing Address - Phone:765-613-0111
Mailing Address - Fax:765-573-5660
Practice Address - Street 1:1320 W SPENCER AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-3415
Practice Address - Country:US
Practice Address - Phone:765-613-0111
Practice Address - Fax:765-573-5660
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002364A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000667093OtherANTHEM
IN200987000Medicaid
INM400019952Medicare PIN