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General NPI Number Information
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NPI Number | 1336751312
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Entity Type | Organization
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Legal Business Name | INDYSTATHEALTHEDU, LLC
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Dates
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Enumeration Date | 08/20/2020
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 9465 COUNSELORS ROW STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3817
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Country | US
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Telephone | 317-260-9333
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Fax |
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Provider Business Mailing Address
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Address Line | 9465 COUNSELORS ROW STE 200
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City | INDIANAPOLIS
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State | IN
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Zip | 46240-3817
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Country | US
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Telephone | 317-260-9333
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR AND DIRECTOR OF ED
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Name | JERUSHA KETURAH SEUNG
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Credential | APRN, FNP-C, WCC
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Telephone | 317-260-9333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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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 | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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