Provider Demographics
NPI:1881727824
Name:CUMMINS, MARSHA MAE (RN, CS, BC)
Entity type:Individual
Prefix:MS
First Name:MARSHA
Middle Name:MAE
Last Name:CUMMINS
Suffix:
Gender:F
Credentials:RN, CS, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 E COUNTY ROAD 250 N
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:IN
Mailing Address - Zip Code:47882-7320
Mailing Address - Country:US
Mailing Address - Phone:859-797-5422
Mailing Address - Fax:
Practice Address - Street 1:2134 MARY SHERMAN DR
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:IN
Practice Address - Zip Code:47882-7625
Practice Address - Country:US
Practice Address - Phone:812-268-6376
Practice Address - Fax:812-268-6377
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN70000014A163WP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000513486OtherANTHEM BLUE CROSS BLUE SHIELD
IN200536950Medicaid
IN000000513486OtherANTHEM BLUE CROSS BLUE SHIELD