Individual
MARISSA SUZANNE MALENKOS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2020 W 86TH ST STE 306, INDIANAPOLIS, IN 46260-1931
(317) 602-1965
Mailing address
8929 SOURWOOD CT, INDIANAPOLIS, IN 46260-1544
(317) 760-6926
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28174774A
IN
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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