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Individual

ADRIENNE N MATHIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
601 W 2ND ST, BLOOMINGTON, IN 47403-2317
(812) 353-9515
Mailing address
PO BOX 1329, BLOOMINGTON, IN 47402-1329

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
10002368A
IN
363A00000X
Physician Assistant
Primary
56156
CA

Other

Enumeration date
07/26/2017
Last updated
01/02/2019
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