Healthcare Provider Details

I. General information

NPI: 1467148601
Provider Name (Legal Business Name): PATIENCE MABASA-NCUBE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SOUTHFIELD DR
PLAINFIELD IN
46168-2955
US

IV. Provider business mailing address

599 LEGACY BLVD
GREENWOOD IN
46143-6427
US

V. Phone/Fax

Practice location:
  • Phone: 317-406-8600
  • Fax:
Mailing address:
  • Phone: 317-353-4759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number71013787A
License Number StateIN

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: