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Individual

DEANNA MARIE MARCUS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
5828 INDEPENDENCE AVE, INDIANAPOLIS, IN 46234-3683
(317) 918-4355
Mailing address
5828 INDEPENDENCE AVE, INDIANAPOLIS, IN 46234-3683
(317) 918-4355

Taxonomy

Speciality
Code
Description
License number
State
171WH0202X
Home Modifications Contractor
10-012343-1
IN
172V00000X
Community Health Worker
Primary
10-012345-1
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201011630A
IN
Enumeration date
06/15/2011
Last updated
06/15/2011
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