Provider Demographics
NPI:1477204055
Name:MESSMER, MARIAH L
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:L
Last Name:MESSMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2514
Mailing Address - Country:US
Mailing Address - Phone:812-996-0299
Mailing Address - Fax:
Practice Address - Street 1:679 S STATE ROAD 145
Practice Address - Street 2:
Practice Address - City:FRENCH LICK
Practice Address - State:IN
Practice Address - Zip Code:47432-8328
Practice Address - Country:US
Practice Address - Phone:812-936-6400
Practice Address - Fax:812-777-4856
Is Sole Proprietor?:No
Enumeration Date:2022-01-14
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71012150A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily