Individual
MASITA ISABEL PORAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
5435 E 16TH ST STE 500, INDIANAPOLIS, IN 46218-4869
(317) 355-8280
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
71006787A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71006787A
IN
363LP2300X
Primary Care Nurse Practitioner
71006787A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201409920
—
IN
01
—
P01824535
RR MEDICARE
IN
Enumeration date
08/02/2016
Last updated
06/22/2021
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