Healthcare Provider Details

I. General information

NPI: 1629746953
Provider Name (Legal Business Name): EMILY HENTZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SILVERCREST DR
NEW ALBANY IN
47150-7800
US

IV. Provider business mailing address

4950 HIGHWAY 337 NW
DEPAUW IN
47115-8708
US

V. Phone/Fax

Practice location:
  • Phone: 812-399-3970
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number28256399A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: