Basic Information
| Provider Information | |||||||||
| NPI: | 1083831424 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCCREARY | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | MSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 N SHADELAND AVE | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462194959 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3179624792 | ||||||||
| FaxNumber: | 3179625580 | ||||||||
| Practice Location | |||||||||
| Address1: | 2620 KESSLER BOULEVARD EAST DR | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462202890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3174756200 | ||||||||
| FaxNumber: | 3174756212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 28044166A | IN | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.