Provider Demographics
NPI:1184622185
Name:VANEVERY, LORETTA M (MD)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:M
Last Name:VANEVERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 W CARMEL DR
Mailing Address - Street 2:SUITE D3
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-8706
Mailing Address - Country:US
Mailing Address - Phone:317-249-0990
Mailing Address - Fax:317-274-0999
Practice Address - Street 1:1806 W ROYALE DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47304-2243
Practice Address - Country:US
Practice Address - Phone:765-747-9951
Practice Address - Fax:765-747-6918
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055474A2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI109803Medicare UPIN
IN114860NNMedicare ID - Type Unspecified