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General NPI Number Information
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NPI Number | 1063887438
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Entity Type | Organization
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Legal Business Name | PAVILION PEDIATRIC CENTER, LLC
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Dates
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Enumeration Date | 12/10/2015
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 3711 N. EVERBROOK LANE
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City | MUNCIE
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State | IN
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Zip | 47304-5270
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Country | US
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Telephone | 765-231-9494
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Fax | 765-587-4456
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Provider Business Mailing Address
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Address Line | 3711 N. EVERBROOK LANE
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City | MUNCIE
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State | IN
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Zip | 47304-5270
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Country | US
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Telephone | 765-231-9494
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Fax | 765-587-4456
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NICOLE RECTOR
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Credential | NP/OWNER
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Telephone | 765-231-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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