Healthcare Provider Details

I. General information

NPI: 1750187522
Provider Name (Legal Business Name): ELIZABETH ROSE DEATON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2025
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 17TH ST
COLUMBUS IN
47201-5351
US

IV. Provider business mailing address

2400 17TH ST
COLUMBUS IN
47201-5351
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-5214
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number28268069A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: