Healthcare Provider Details

I. General information

NPI: 1477234094
Provider Name (Legal Business Name): OLIVIA HORNEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2023
Last Update Date: 07/27/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E HANNA AVE
INDIANAPOLIS IN
46227-3630
US

IV. Provider business mailing address

520 E MAIN ST
GREENWOOD IN
46143-1367
US

V. Phone/Fax

Practice location:
  • Phone: 317-788-3368
  • Fax:
Mailing address:
  • Phone: 317-941-9785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: