Healthcare Provider Details

I. General information

NPI: 1649482423
Provider Name (Legal Business Name): WELLSTONE NURSE PRACTITIONER GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 VISSING PARK ROAD
JEFFERSONVILLE IN
47130
US

IV. Provider business mailing address

2700 VISSING PARK ROAD
JEFFERSONVILLE IN
47130
US

V. Phone/Fax

Practice location:
  • Phone: 812-284-8000
  • Fax: 812-258-1094
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: PATRICK T HAMMER
Title or Position: CEO
Credential:
Phone: 812-284-8000