Provider Demographics
NPI:1548214109
Name:ELIAS, MARY ESTHER (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ESTHER
Last Name:ELIAS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9821 LIMA RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46818-8656
Practice Address - Country:US
Practice Address - Phone:260-240-5027
Practice Address - Fax:260-209-5119
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001971A363LF0000X
FLARNP3351692363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200842210Medicaid
INP44032Medicare UPIN
IN200842210Medicaid
IN150640JJMedicare PIN