Healthcare Provider Details

I. General information

NPI: 1750928362
Provider Name (Legal Business Name): KARL NORRIS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 12/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 BUREAU RD N
TERRE HAUTE IN
47802-8128
US

IV. Provider business mailing address

336 W VILLAGE DR
SULLIVAN IN
47882-7510
US

V. Phone/Fax

Practice location:
  • Phone: 812-244-4400
  • Fax:
Mailing address:
  • Phone: 812-201-8956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71009379A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: