Individual
MARLEY P OLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
727 W 2ND ST, BLOOMINGTON, IN 47403-2209
(812) 353-3450
(812) 353-3451
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71012876A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1102662771
ANTHEM PTAN
IN
05
—
300068097
—
IN
Enumeration date
06/23/2022
Last updated
10/21/2024
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