Individual
MELISSA ANN GWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 838-4215
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
71002825A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71002825A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000610495
ANTHEM PROVIDER NUMBER
IN
01
—
12736891
PHCS NUMBER / MULTIPLAN
IN
05
—
200937540
—
IN
Enumeration date
09/23/2008
Last updated
11/05/2024
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