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Individual

MRS. LYNDA MARIE WEATHERS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 988-9407
Mailing address
1481 W 10TH ST, INDIANAPOLIS, IN 46202-2803
(317) 988-9407

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28149261A
IN
363LF0000X
Family Nurse Practitioner
Primary
71003250A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000709524
ANTHEM
IN
05
200998320
IN
Enumeration date
07/19/2010
Last updated
03/23/2017
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