Provider Demographics
NPI:1366920266
Name:CLOSSER, MINDY (NP)
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:CLOSSER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MEMORIAL SQ STE 50
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1357
Mailing Address - Country:US
Mailing Address - Phone:317-468-6270
Mailing Address - Fax:317-468-6268
Practice Address - Street 1:300 E BOYD AVE STE 250
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-2845
Practice Address - Country:US
Practice Address - Phone:317-467-4500
Practice Address - Fax:317-477-6321
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28147441A163WP0200X
IN71008300A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0200XNursing Service ProvidersRegistered NursePediatrics