Healthcare Provider Details

I. General information

NPI: 1275917031
Provider Name (Legal Business Name): ELISE BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2015
Last Update Date: 07/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5117 CHATHAM PL
INDIANAPOLIS IN
46226-2272
US

IV. Provider business mailing address

5117 CHATHAM PL
INDIANAPOLIS IN
46226-2272
US

V. Phone/Fax

Practice location:
  • Phone: 317-938-8105
  • Fax: 317-405-9424
Mailing address:
  • Phone: 317-938-8105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: