Healthcare Provider Details

I. General information

NPI: 1295040848
Provider Name (Legal Business Name): SARAH ELIZABETH ICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 08/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BELLEMEADE AVE SUITE 200E
EVANSVILLE IN
47714-0100
US

IV. Provider business mailing address

3801 BELLEMEADE AVE SUITE 340
EVANSVILLE IN
47714-0100
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-1720
  • Fax: 812-485-1775
Mailing address:
  • Phone: 812-485-1827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003314A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: