Healthcare Provider Details

I. General information

NPI: 1811977630
Provider Name (Legal Business Name): LISA MARIE BOZARTH ARNP/CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 09/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 MEDIC WAY
GREENCASTLE IN
46135-2296
US

IV. Provider business mailing address

10330 N MERIDIAN ST SUITE 201
INDIANAPOLIS IN
46290-1024
US

V. Phone/Fax

Practice location:
  • Phone: 765-653-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003235A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: