Provider Demographics
NPI:1336231133
Name:MENNER, THERESA KAY (NP)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:KAY
Last Name:MENNER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:KAY
Other - Last Name:MENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:34 W 59TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46208-1513
Mailing Address - Country:US
Mailing Address - Phone:317-257-2636
Mailing Address - Fax:
Practice Address - Street 1:8244 E. US 36
Practice Address - Street 2:STE. 1100, HENDRICKS REGIONAL HEALTH IMMEDIATE CARE
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-9627
Practice Address - Country:US
Practice Address - Phone:317-272-7500
Practice Address - Fax:317-272-7515
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000199A363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily