Provider Demographics
NPI:1821289497
Name:GEMMER, NANCY JO (PHDHSPP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:GEMMER
Suffix:
Gender:F
Credentials:PHDHSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8112 HILL TOP LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-2037
Mailing Address - Country:US
Mailing Address - Phone:317-590-4297
Mailing Address - Fax:
Practice Address - Street 1:8112 HILL TOP LN
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-2037
Practice Address - Country:US
Practice Address - Phone:317-590-4297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040468A103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN252320Medicare PIN