Provider Demographics
NPI:1790161800
Name:MULVANEY, BARBARA A (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:MULVANEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BARBIE
Other - Middle Name:A
Other - Last Name:MULVANEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 3038C
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-2617
Practice Address - Fax:317-278-2587
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28177135363LP0200X
IN71005626A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201308980Medicaid
IN145590098Medicare PIN