Individual
MARY LOU ERTEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
2600 GREENBUSH ST, LAFAYETTE, IN 47904-2479
(765) 448-8000
(765) 448-8227
Mailing address
PO BOX 5545, LAFAYETTE, IN 47903-5545
(765) 448-8000
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
71000614A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000351156
ANTHEM PROVIDER PIN
IN
05
—
200465780
—
IN
01
—
9397619
PHCS PID NUMBER
IN
Enumeration date
03/23/2006
Last updated
07/23/2012
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