Provider Demographics
NPI:1679296859
Name:ANDONIAN, MARGARET ROSE
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ROSE
Last Name:ANDONIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:ROSE
Other - Last Name:FILLMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10716 SHERBORNE RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2671
Mailing Address - Country:US
Mailing Address - Phone:765-744-4440
Mailing Address - Fax:
Practice Address - Street 1:124 W MUSKEGON DR
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-3069
Practice Address - Country:US
Practice Address - Phone:317-468-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013393A363LF0000X
IN28224093A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse