Individual
MICHELLE MABIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1396 BRIGADE CIR, INDIANAPOLIS, IN 46234-9795
(317) 908-9071
Mailing address
1396 BRIGADE CIR, INDIANAPOLIS, IN 46234-9795
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28172272A
IN
363L00000X
Nurse Practitioner
Primary
71004738A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201203550
—
IN
01
—
P01307687
MEDICARE RR PTAN
IN
Enumeration date
10/30/2013
Last updated
10/29/2019
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