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General NPI Number Information
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NPI Number | 1023223633
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Entity Type | Organization
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Legal Business Name | INNOVATIVE HEALTH CONCEPTS
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1201 DALY DR
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City | NEW HAVEN
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State | IN
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Zip | 46774-1891
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Country | US
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Telephone | 260-413-2958
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Fax |
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Provider Business Mailing Address
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Address Line | 9410 STOCKBRIDGE WAY
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City | NEW HAVEN
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State | IN
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Zip | 46774-2719
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Country | US
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Telephone | 260-413-2958
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | SARA L BAUER
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Credential | NP
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Telephone | 260-413-2958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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