Individual
MRS. DOROTHY ROBERTA SELF
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
1700 N CAPITOL AVE, B465, INDIANAPOLIS, IN 46202
(317) 962-0745
(317) 962-8349
Mailing address
PO BOX 1367, B465, INDIANAPOLIS, IN 46206-1367
(317) 962-0745
(317) 962-8349
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000600
IN
Other
Enumeration date
11/07/2007
Last updated
11/07/2007
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