Provider Demographics
NPI:1548259625
Name:AVELINE, ANNA MARIE (NP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:AVELINE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:MARIE
Other - Last Name:HAUSSECKER AVELINE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 746720
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6720
Mailing Address - Country:US
Mailing Address - Phone:312-733-9730
Mailing Address - Fax:773-866-8014
Practice Address - Street 1:4200 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1534
Practice Address - Country:US
Practice Address - Phone:317-991-7600
Practice Address - Fax:317-215-7030
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28083833A163W00000X
IN71001885A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00220524OtherRR MEDICARE
IN200511060AMedicaid
IN000000491145OtherANTHEM BCBC
Q4426BMedicare UPIN
IN200511060AMedicaid