Healthcare Provider Details

I. General information

NPI: 1396081063
Provider Name (Legal Business Name): FAYE E. RUPERT CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2012
Last Update Date: 12/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 HARTFORD ST
LAFAYETTE IN
47904-2134
US

IV. Provider business mailing address

5303 CHEVIOT PL
INDIANAPOLIS IN
46226-3239
US

V. Phone/Fax

Practice location:
  • Phone: 765-423-6796
  • Fax:
Mailing address:
  • Phone: 317-549-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number28124974A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: