Healthcare Provider Details

I. General information

NPI: 1972194561
Provider Name (Legal Business Name): BEAU PRESCOTT SEMLER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 HOSPITAL LN STE 303
DANVILLE IN
46122-1998
US

IV. Provider business mailing address

1917 ABBEY LN
DANVILLE IN
46122-9538
US

V. Phone/Fax

Practice location:
  • Phone: 317-718-4000
  • Fax:
Mailing address:
  • Phone: 317-695-6145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number71010794A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28164648A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: