Provider Demographics
NPI:1669911103
Name:MIGNONETTE DARLENE
Entity type:Organization
Organization Name:MIGNONETTE DARLENE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MIGNONETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARLENE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:919-438-7899
Mailing Address - Street 1:8108 E 36TH ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-6431
Mailing Address - Country:US
Mailing Address - Phone:919-438-7899
Mailing Address - Fax:
Practice Address - Street 1:8108 E 36TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-6431
Practice Address - Country:US
Practice Address - Phone:919-438-7899
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006769A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty