Healthcare Provider Details

I. General information

NPI: 1043733751
Provider Name (Legal Business Name): JANE ROEI YIP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1033 THIRD AVE SW, SUITE 109
CARMEL IN
46032
US

IV. Provider business mailing address

1033 3RD AVE SW STE 109
CARMEL IN
46032-7592
US

V. Phone/Fax

Practice location:
  • Phone: 317-503-1296
  • Fax: 317-853-6743
Mailing address:
  • Phone: 317-503-1296
  • Fax: 317-853-6743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-17-25892
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: