Healthcare Provider Details

I. General information

NPI: 1033103866
Provider Name (Legal Business Name): BARBARA DEICH NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 16TH ST
BEDFORD IN
47421-3510
US

IV. Provider business mailing address

2900 16TH ST
BEDFORD IN
47421-3510
US

V. Phone/Fax

Practice location:
  • Phone: 812-275-5352
  • Fax: 812-275-1374
Mailing address:
  • Phone: 812-275-5352
  • Fax: 812-275-1374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000986A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: