Individual
NICOLE PATRICE MYERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1520 S LIBERTY DR, BLOOMINGTON, IN 47403-5167
(812) 676-4300
(812) 339-8399
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28208899A
IN
363LA2100X
Acute Care Nurse Practitioner
Primary
71015484A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104449198
ANTHEM PTAN
IN
Enumeration date
05/15/2024
Last updated
10/31/2024
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