Mara Nicole Humberg, NP
Nurse Practitioner, Pediatrics in Lafayette, IN. Individual provider (NPI-1).
NPI number1760089445
StatusActive
Last updated in NPPESMay 9, 2022
Details
- NPI
- 1760089445
- Entity type
- Individual (NPI-1)
- Name
- Mara Nicole Humberg
- Credential
- NP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 6, 2020
- Certification date
- May 9, 2022
- Last updated
- May 9, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - NURSE PRACTITIONER
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility Yes · Hospice No
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 71011419A | IN | Yes |
| 163W00000X | Registered Nurse | 28224434A | IN |
Other names
- Mara Nicole Lavelle (Former Name)
Practice location
2316 South StLafayette, IN 47904-2971
Phone 765-742-1567 · Fax 765-742-2750
Mailing address
1716 Hartford StLafayette, IN 47904-2138
Phone 765-742-1567 · Fax 765-429-2700
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 20 Pediatric Nurse Practitioner providers in Lafayette · All 3,396 providers in Lafayette
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