Basic Information
| Provider Information | |||||||||
| NPI: | 1336231133 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MENNER | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | KAY | ||||||||
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| Credential: | NP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | MENNER | ||||||||
| OtherFirstName: | TERRY | ||||||||
| OtherMiddleName: | KAY | ||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 34 W 59TH ST | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462081513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172572636 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8244 E. US 36 | ||||||||
| Address2: | STE. 1100, HENDRICKS REGIONAL HEALTH IMMEDIATE CARE | ||||||||
| City: | AVON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461239627 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3172727500 | ||||||||
| FaxNumber: | 3172727515 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 08/20/2010 | ||||||||
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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 | 363LF0000X | 70000199A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 70000199A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.