Healthcare Provider Details

I. General information

NPI: 1780243972
Provider Name (Legal Business Name): ZACHARY EPPERT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2019
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 E 52ND ST
INDIANAPOLIS IN
46205-1377
US

IV. Provider business mailing address

1919 E 52ND ST
INDIANAPOLIS IN
46205-1377
US

V. Phone/Fax

Practice location:
  • Phone: 317-429-0120
  • Fax:
Mailing address:
  • Phone: 317-429-0120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number71009013A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71009013A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number28196594A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: