Provider Demographics
NPI:1275293342
Name:MARCOTTE, LIANE MICHELE (PMHNP)
Entity Type:Individual
Prefix:
First Name:LIANE
Middle Name:MICHELE
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:755 W CARMEL DR STE 206
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5878
Mailing Address - Country:US
Mailing Address - Phone:317-804-3696
Mailing Address - Fax:317-836-1520
Practice Address - Street 1:755 W CARMEL DR STE 206
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5878
Practice Address - Country:US
Practice Address - Phone:317-702-1600
Practice Address - Fax:317-836-1520
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN71012964B363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program