Healthcare Provider Details

I. General information

NPI: 1952334252
Provider Name (Legal Business Name): WALL STREET INTERNAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 QUARTER MASTER CRT
JEFFERSONVILLE IN
47130-3759
US

IV. Provider business mailing address

73 QUARTER MASTER CRT SUITE 100
JEFFERSONVILLE IN
47130-3759
US

V. Phone/Fax

Practice location:
  • Phone: 812-288-8360
  • Fax: 812-288-8375
Mailing address:
  • Phone: 812-288-8360
  • Fax: 812-288-8375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHELSEA JANE NEVITT
Title or Position: OWNER, PHYSICIAN
Credential: M.D
Phone: 812-288-8360