Healthcare Provider Details

I. General information

NPI: 1508468190
Provider Name (Legal Business Name): LILITH JEWELL HUTCHINSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2020
Last Update Date: 11/10/2020
Certification Date: 11/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8355 ROCKVILLE RD
INDIANAPOLIS IN
46234-2722
US

IV. Provider business mailing address

4407 N SHERIDAN AVE
INDIANAPOLIS IN
46226-3537
US

V. Phone/Fax

Practice location:
  • Phone: 317-429-0061
  • Fax:
Mailing address:
  • Phone: 317-373-3792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28080994A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: