Healthcare Provider Details

I. General information

NPI: 1386924447
Provider Name (Legal Business Name): INDIANA UNIVERSITY HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 09/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 BARNHILL DR SUITE 2500
INDIANAPOLIS IN
46202-5128
US

IV. Provider business mailing address

702 BARNHILL DR SUITE 2500
INDIANAPOLIS IN
46202-5128
US

V. Phone/Fax

Practice location:
  • Phone: 317-948-4949
  • Fax:
Mailing address:
  • Phone: 317-948-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number28170497A
License Number StateIN

VIII. Authorized Official

Name: MRS. ALEXIS N YOO
Title or Position: NURSE PRACTITIONER
Credential: RN, MSN,CPNP
Phone: 219-808-3680