Individual
MS. MARY JACQUELINE WHARTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
441 N WABASH AVE, MARION, IN 46952-2612
(765) 660-6900
Mailing address
330 N WABASH, STE G20, MARION, IN 46952
(765) 660-7616
(765) 651-7313
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
28209999A
IN
363LF0000X
Family Nurse Practitioner
28209999A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001270272
ANTHEM
IN
05
—
300025020
—
IN
Enumeration date
03/25/2019
Last updated
06/11/2019
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