Healthcare Provider Details

I. General information

NPI: 1659884203
Provider Name (Legal Business Name): GBU, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N ROYAL AVE
EVANSVILLE IN
47715-7843
US

IV. Provider business mailing address

2221 SABLE WAY
NEWBURGH IN
47630-8098
US

V. Phone/Fax

Practice location:
  • Phone: 812-475-9199
  • Fax:
Mailing address:
  • Phone: 618-889-8101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateIN

VIII. Authorized Official

Name: VIRGINIA STEINER
Title or Position: PRRESIDENT
Credential:
Phone: 618-899-8101