Healthcare Provider Details

I. General information

NPI: 1871709600
Provider Name (Legal Business Name): MRS. JAN ELLEN TAYLOR SCHULTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAN ELLEN TAYLOR

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3925 HAGAN STREET SUITE 203
BLOOMINGTON IN
49401
US

IV. Provider business mailing address

3925 HAGAN STREET SUITE 203
BLOOMINGTON IN
49401
US

V. Phone/Fax

Practice location:
  • Phone: 812-334-0001
  • Fax:
Mailing address:
  • Phone: 812-334-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34003957A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: