Provider Demographics
NPI:1871105205
Name:BLAND, ROSEMARY (NP)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:BLAND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:RUTAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-777-6435
Mailing Address - Fax:317-777-6644
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 1134
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-944-8906
Practice Address - Fax:317-944-9330
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28173872A363LF0000X
IN71010225A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily