Healthcare Provider Details

I. General information

NPI: 1992081236
Provider Name (Legal Business Name): BARBARA JANE CONNER SW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2011
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 W HOSPITAL RD
PAOLI IN
47454-8807
US

IV. Provider business mailing address

PO BOX 769 480 EVERSMAN DRIVE
JASPER IN
47547-0769
US

V. Phone/Fax

Practice location:
  • Phone: 812-723-4301
  • Fax: 812-723-4306
Mailing address:
  • Phone: 812-482-3020
  • Fax: 812-482-6409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number99048982A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: