Individual
MRS. GLADYS E BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
441 N WABASH AVE, MARION, IN 46952-2612
(765) 660-6411
(765) 651-7313
Mailing address
330 NORTH WABASH, SUITE G20, MARION, IN 46952-2600
(765) 660-7600
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
71002475Z
IN
363L00000X
Nurse Practitioner
71002475A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71002475A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000645919
ANTHEM
IN
05
—
200982170
—
IN
Enumeration date
01/02/2008
Last updated
03/27/2018
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