Healthcare Provider Details

I. General information

NPI: 1164802732
Provider Name (Legal Business Name): NUSTART HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2015
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

797 S WABASH ST
WABASH IN
46992-3332
US

IV. Provider business mailing address

797 S WABASH ST
WABASH IN
46992-3332
US

V. Phone/Fax

Practice location:
  • Phone: 260-563-0700
  • Fax: 260-274-0135
Mailing address:
  • Phone: 260-563-0700
  • Fax: 260-274-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003352A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number208D00000X
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003888A
License Number StateIN

VIII. Authorized Official

Name: DR. JAIME N LINDSAY
Title or Position: OWNER/AUTHORIZED OFFICIAL
Credential: D.O.
Phone: 260-563-0700