Healthcare Provider Details

I. General information

NPI: 1235326927
Provider Name (Legal Business Name): MARY ELIZABETH RUMMEL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2007
Last Update Date: 11/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 VIRGINIA AVE
CONNERSVILLE IN
47331-2971
US

IV. Provider business mailing address

1941 VIRGINIA AVE
CONNERSVILLE IN
47331-2833
US

V. Phone/Fax

Practice location:
  • Phone: 765-827-8064
  • Fax: 765-827-8878
Mailing address:
  • Phone: 765-827-8064
  • Fax: 765-827-8878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002508A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: