Provider Demographics
NPI:1760785786
Name:TORRES, AIDA L (NP)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:L
Last Name:TORRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AIDA
Other - Middle Name:L
Other - Last Name:MANFREDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:317-621-1886
Mailing Address - Fax:317-957-2891
Practice Address - Street 1:1402 E COUNTY LINE RD
Practice Address - Street 2:SUITE 2400
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-0963
Practice Address - Country:US
Practice Address - Phone:317-887-7880
Practice Address - Fax:317-887-7886
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003479A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01214724OtherRR MEDICARE PTAN
IN201005850Medicaid
INM400039325Medicare PIN
INM400039338Medicare PIN
IN266180158Medicare PIN
IN201005850Medicaid
INM400039332Medicare PIN
INP01214724OtherRR MEDICARE PTAN
INM400053967Medicare PIN
INM400039330Medicare PIN
INM400039322Medicare PIN
INM400039336Medicare PIN