Provider Demographics
NPI:1205369923
Name:NADERI, MARZIEH T (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARZIEH
Middle Name:T
Last Name:NADERI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SUE
Other - Middle Name:
Other - Last Name:NADERI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-3137
Mailing Address - Fax:
Practice Address - Street 1:13000 E 136TH ST
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9478
Practice Address - Country:US
Practice Address - Phone:317-678-2000
Practice Address - Fax:317-924-9424
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28196023A163W00000X
IN71007253A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse