Individual
EMILY MAZANOWSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
7930 N SHADELAND AVE, INDIANAPOLIS, IN 46250-2041
(317) 621-6725
(317) 621-4545
Mailing address
6626 E 75TH ST, STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000899969
ANTHEM
—
05
—
300005118
—
IN
05
—
OPR
—
IN
Enumeration date
09/04/2014
Last updated
11/27/2023
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