Provider Demographics
NPI:1750136792
Name:COLE, MARLENA M
Entity type:Individual
Prefix:
First Name:MARLENA
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2617 SATURN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-1155
Mailing Address - Country:US
Mailing Address - Phone:317-828-5655
Mailing Address - Fax:317-449-8451
Practice Address - Street 1:2617 SATURN DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-1155
Practice Address - Country:US
Practice Address - Phone:317-828-5655
Practice Address - Fax:317-449-8451
Is Sole Proprietor?:No
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-016108-13747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider