Healthcare Provider Details

I. General information

NPI: 1013279835
Provider Name (Legal Business Name): JEANIE HAN COLLINS MSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JEANIE YOUNGMEE HAN MSA

II. Dates (important events)

Enumeration Date: 06/08/2012
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 ESKENAZI AVENUE
INDIANAPOLIS IN
46202-5166
US

IV. Provider business mailing address

720 ESKENAZI AVENUE FIFTH THIRD BANK BLDG., 5TH FLOOR
INDIANAPOLIS IN
46202-5166
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-5542
  • Fax: 317-554-2721
Mailing address:
  • Phone: 317-670-4507
  • Fax: 317-880-0498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: