Healthcare Provider Details

I. General information

NPI: 1073645081
Provider Name (Legal Business Name): HENDRICKS REGIONAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

IV. Provider business mailing address

1000 E MAIN ST
DANVILLE IN
46122-1948
US

V. Phone/Fax

Practice location:
  • Phone: 317-745-9531
  • Fax: 317-745-9534
Mailing address:
  • Phone: 317-745-9531
  • Fax: 317-745-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71002313A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71003410B
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000117B
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number72000005B
License Number StateIN

VIII. Authorized Official

Name: LYNN E DEVICH
Title or Position: DIRECTOR
Credential: MSN, RN
Phone: 317-745-7205