Healthcare Provider Details

I. General information

NPI: 1568975878
Provider Name (Legal Business Name): RMD HEALTH & WELLNESS CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S 8TH ST
RICHMOND IN
47374-6901
US

IV. Provider business mailing address

1100 REID PARKWAY MEDICAL STAFF SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-939-3947
  • Fax: 765-939-3950
Mailing address:
  • Phone: 765-939-3947
  • Fax: 765-939-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateIN

VIII. Authorized Official

Name: MISTY NASH
Title or Position: DIRECTOR
Credential: CPCS
Phone: 765-983-3127