Provider Demographics
NPI:1235591975
Name:LEMMA, AZEB (NP)
Entity Type:Individual
Prefix:
First Name:AZEB
Middle Name:
Last Name:LEMMA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-935-8773
Mailing Address - Fax:765-935-8774
Practice Address - Street 1:1100 REID PKWY
Practice Address - Street 2:SUITE 105
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-935-8773
Practice Address - Fax:765-935-8774
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006213A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201355000Medicaid
OH0166922Medicaid
IN000001012321OtherANTHEM
IN259370150Medicare PIN