Provider Demographics
NPI:1548732357
Name:MCMAHON, MARISSA (APN-WHNP)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:APN-WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2074 MOBLEY DR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9896
Mailing Address - Country:US
Mailing Address - Phone:317-430-1326
Mailing Address - Fax:
Practice Address - Street 1:8590 GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1647
Practice Address - Country:US
Practice Address - Phone:317-872-3115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209018511363LW0102X
IN71009725A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health