Individual
MYCHEALE GRUNDY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1232 N LAYMAN AVE, INDIANAPOLIS, IN 46219-3106
(317) 654-0442
Mailing address
1232 N LAYMAN AVE, INDIANAPOLIS, IN 46219-3106
(317) 654-0442
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
—
—
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
87-2140837
—
IN
Enumeration date
09/27/2022
Last updated
09/29/2022
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