Provider Demographics
NPI:1275500241
Name:AYER, MARILYN J (APRN)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:J
Last Name:AYER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8623 N 275 E
Mailing Address - Street 2:
Mailing Address - City:CHRISNEY
Mailing Address - State:IN
Mailing Address - Zip Code:47611
Mailing Address - Country:US
Mailing Address - Phone:812-362-8323
Mailing Address - Fax:
Practice Address - Street 1:27 EAST HIGHWAY 66
Practice Address - Street 2:
Practice Address - City:TELL CITY
Practice Address - State:IN
Practice Address - Zip Code:47586-2044
Practice Address - Country:US
Practice Address - Phone:812-395-2011
Practice Address - Fax:270-395-2012
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2011-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1025505163W00000X
IN28049367A163W00000X
IN71002269A363LF0000X
KY3002878363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200878830Medicaid
KY7801574000Medicaid
000000498490OtherANTHEM # - CHS, INC.
KY7801574000Medicaid
KY3397735Medicare PIN
KYS78415Medicare UPIN
IN200878830Medicaid