Individual
MARA NICOLE HUMBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2316 SOUTH ST, LAFAYETTE, IN 47904-2971
(765) 742-1567
(765) 742-2750
Mailing address
1716 HARTFORD ST, LAFAYETTE, IN 47904-2138
(765) 742-1567
(765) 429-2700
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28224434A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
71011419A
IN
Other
Enumeration date
10/06/2020
Last updated
05/09/2022
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