Ertel, Mary Lou

Ertel, Mary Lou is an individual health care provider with primary practice located at 2600 Greenbush St , Lafayette IN 47904-2479. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Primary Care, which is considered as her primary health care specialty. Ertel, Mary Lou can be contacted via phone (765) 448-8000.

Contact Information

Primary practice address
2600 Greenbush St Lafayette IN 47904-2479
Phone: (765) 448-8000
Fax: (765) 448-8227
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Primary Care 363LP2300X 71000614A Indiana

Profile Details

NPI number 1639138993
LBN Legal business name Ertel, Mary Lou
Credentials Certified Pediatric Nurse Practitioner (CPNP)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 23rd, 2006
Last updated Jul 23rd, 2012 - about 12 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 1639138993 NPPES
Indiana Other 000000351156 ANTHEM PROVIDER PIN
Indiana Other 9397619 ANTHEM PROVIDER PIN
Indiana MEDICAID 200465780 ANTHEM PROVIDER PIN

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