Provider Demographics
NPI:1356325484
Name:KINNAMAN, MARLA J (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARLA
Middle Name:J
Last Name:KINNAMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:8325 E SOUTHPORT RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46259-6805
Mailing Address - Country:US
Mailing Address - Phone:317-862-6609
Mailing Address - Fax:317-862-4617
Practice Address - Street 1:9115 HAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1025
Practice Address - Country:US
Practice Address - Phone:317-521-3780
Practice Address - Fax:317-521-4435
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN28113588A163W00000X
IN71001395A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse