Brock, Mary Jo

Brock, Mary Jo is an individual health care provider with primary practice located at 705 Riley Hospital Dr Rr 208, Indianapolis IN 46202-5109. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Neonatal, which is considered as her primary health care specialty. Brock, Mary Jo can be contacted via phone (317) 274-4715.

Contact Information

Primary practice address
705 Riley Hospital Dr Rr 208 Indianapolis IN 46202-5109
Phone: (317) 274-4715
Fax: (317) 274-2065
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X 71001637 Indiana
Physician Assistants & Advanced Practice Nursing Providers / Neonatal 363LN0000X 28077995 Indiana

Profile Details

NPI number 1770657348
LBN Legal business name Brock, Mary Jo
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 17th, 2006
Last updated Mar 2nd, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770657348 NPPES
Indiana MEDICAID 200367730

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