Provider Demographics
NPI:1922080472
Name:HERNLY, ELIZABETH ANN (NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:HERNLY
Suffix:
Gender:F
Credentials:NP
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Other - First Name:
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Mailing Address - Street 1:3266 N MERIDIAN ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-5846
Mailing Address - Country:US
Mailing Address - Phone:317-924-8208
Mailing Address - Fax:317-924-8348
Practice Address - Street 1:3266 N MERIDIAN ST
Practice Address - Street 2:SUITE 704
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-5846
Practice Address - Country:US
Practice Address - Phone:317-924-8297
Practice Address - Fax:317-924-8239
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN71000021A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INS81577Medicare UPIN
IN331620JMedicare ID - Type UnspecifiedMEMORIAL CLINIC MEDICARE
IN234200DMedicare ID - Type UnspecifiedAACI - MEDICARE NUMBER