Healthcare Provider Details

I. General information

NPI: 1720825938
Provider Name (Legal Business Name): CAMRYN MICHELLE ZUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/15/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2651 E DISCOVERY PKWY
BLOOMINGTON IN
47408-9059
US

IV. Provider business mailing address

467 S SERENITY WAY
GREENWOOD IN
46142-8438
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-8157
  • Fax:
Mailing address:
  • Phone: 317-767-9614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: