Healthcare Provider Details

I. General information

NPI: 1457648388
Provider Name (Legal Business Name): AMY CREASAP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 06/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 W 84TH ST
INDIANAPOLIS IN
46278-1360
US

IV. Provider business mailing address

200 NORTHLAND BLVD 1ST FLOOR
CINCINNATI OH
45246-3604
US

V. Phone/Fax

Practice location:
  • Phone: 317-956-6228
  • Fax: 317-956-6289
Mailing address:
  • Phone: 513-672-3309
  • Fax: 513-672-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28196146A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: