Provider Demographics
NPI:1740431154
Name:MOSES, MARLA S (FNP)
Entity type:Individual
Prefix:
First Name:MARLA
Middle Name:S
Last Name:MOSES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MARLA
Other - Middle Name:S
Other - Last Name:KNECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:ROC 4270
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-274-7208
Practice Address - Fax:317-274-3442
Is Sole Proprietor?:No
Enumeration Date:2008-10-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002822A363LF0000X
IN28150368363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000605105OtherANTHEM PROVIDER NUMBER
IN200933100Medicaid
INP00732713Medicare PIN
IN000000605105OtherANTHEM PROVIDER NUMBER