Healthcare Provider Details

I. General information

NPI: 1376781047
Provider Name (Legal Business Name): CHARLOTTE R IPACH MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2009
Last Update Date: 02/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

285 BIELBY RD
LAWRENCEBURG IN
47025-1055
US

IV. Provider business mailing address

285 BIELBY RD
LAWRENCEBURG IN
47025-1055
US

V. Phone/Fax

Practice location:
  • Phone: 812-537-1302
  • Fax:
Mailing address:
  • Phone: 812-537-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number28126145A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: