Healthcare Provider Details

I. General information

NPI: 1508953076
Provider Name (Legal Business Name): CAROL BEALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 S WOODSCREST DR
BLOOMINGTON IN
47401-5314
US

IV. Provider business mailing address

3004 FOREST RIDGE DR
BLOOMINGTON IN
47401-9639
US

V. Phone/Fax

Practice location:
  • Phone: 812-353-3333
  • Fax: 812-323-8528
Mailing address:
  • Phone: 812-824-7164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number71000655A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: