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Individual

MARIEL ANNE P NETHERTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
705 RILEY HOSPITAL DR # K1925, INDIANAPOLIS, IN 46202-5109
(317) 944-5000
(317) 963-5492
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004161A
IN
363AM0700X
Medical Physician Assistant
10004161A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1103735587
ANTHEM PTAN
IN
05
300083034
IN
Enumeration date
10/13/2023
Last updated
02/14/2025
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