MEDICARE: ELLA BOARDLEY

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
1	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740026715
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLA BOARDLEY

Provider Business Mailing Address
First Line	:	825 GARDENBROOK CIR APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-4671
Country	:	US
Telephone Number	:	574-440-5218
Fax Number	:

Provider Business Practice Location Address
First Line	:	825 GARDENBROOK CIR APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-4671
Country	:	US
Telephone Number	:	574-440-5218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2024
Last Update Date	:	07/08/2024

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Directions to “ ELLA BOARDLEY ” Practice Location

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