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Individual

MICHELLE YAKIMICKI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1501
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28192763A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71007259A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000001099880
ANTHEM PROVIDER NUMBER
IN
05
300005004
IN
Enumeration date
03/06/2017
Last updated
03/02/2021
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