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NPI Code Detail

MEDICARE: ELISABETH K DEGENHARDT RN, MSN

MEDICARE: ELISABETH K DEGENHARDT RN, MSN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1364SP0808XPsychiatric/Mental Health Clinical Nurse Specialist70000009CIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
128089558AOTHERINRN LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508041716
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELISABETH K DEGENHARDT RN, MSN
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line : STE 130 PROVIDER ENROLLMENT
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5230 E STOP 11 RD STE 300
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-6401
Country : US
Telephone Number : 317-781-4588
Fax Number : 317-782-4885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/07/2008
Last Update Date : 03/07/2023

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