Provider Demographics
NPI:1588175921
Name:HEALY, DARLA JEAN
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:JEAN
Last Name:HEALY
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 1:6330 E 75TH ST STE 174
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2781
Mailing Address - Country:US
Mailing Address - Phone:317-296-7730
Mailing Address - Fax:317-545-1877
Practice Address - Street 1:6330 E 75TH ST STE 174
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2781
Practice Address - Country:US
Practice Address - Phone:317-296-7730
Practice Address - Fax:317-545-1877
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2017-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN79000036A163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator