Individual
MARY E LERZAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1633 N CAPITOL AVE, STE 322, INDIANAPOLIS, IN 46202-1476
(317) 962-2929
(317) 962-2070
Mailing address
250 N SHADELAND AVE, SUITE 130 - PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71000198A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71000198A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200189720
—
IN
Enumeration date
05/25/2006
Last updated
10/23/2013
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