Individual
MALLORY N MINYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
550 UNIVERSITY BLVD # UH1501, INDIANAPOLIS, IN 46202-5149
(317) 948-1310
(317) 948-0503
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363LC0200X
Critical Care Medicine Nurse Practitioner
71015707A
IN
363LF0000X
Family Nurse Practitioner
Primary
71015707A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1104361114
ANTHEM PTAN
IN
05
—
300096243
—
IN
Enumeration date
09/03/2024
Last updated
10/17/2024
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