Individual
MICHELLE HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1399 N BALDWIN AVENUE, MARION, IN 46952-2561
(765) 660-7550
(765) 662-4467
Mailing address
330 N WABASH AVENUE, STE G20, MARION, IN 46952-2600
(765) 660-7616
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006107A
IN
363LF0000X
Family Nurse Practitioner
71006107A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000996990
ANTHEM
IN
05
—
201348890
—
IN
Enumeration date
02/02/2016
Last updated
10/20/2020
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