Provider Demographics
NPI:1164694345
Name:MERRIWEATHER, CARMEN (MEDICAL ASSISTANT)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:MERRIWEATHER
Suffix:
Gender:F
Credentials:MEDICAL ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7007 GRAHAM ROAD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-0071
Mailing Address - Country:US
Mailing Address - Phone:317-820-3565
Mailing Address - Fax:317-375-6470
Practice Address - Street 1:7007 GRAHAM ROAD
Practice Address - Street 2:SUITE 215
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3235
Practice Address - Country:US
Practice Address - Phone:317-820-3565
Practice Address - Fax:317-375-6470
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN48-01-04-05216376K00000X
3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376K00000XNursing Service Related ProvidersNurse's Aide