=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518394402
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT PROVIDER HEALTH SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/09/2013
-----------------------------------------------------
Last Update Date | 01/25/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4267 LAFAYETTE RD
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46254-2409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-205-9710
-----------------------------------------------------
Fax | 317-205-9711
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 662 JACKSON ST
-----------------------------------------------------
City | BROWNSBURG
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46112-1680
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-205-9710
-----------------------------------------------------
Fax | 317-205-9711
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF EXECUTIVE OFFICER/NP
-----------------------------------------------------
Name | DR. DORIS A NARTEY
-----------------------------------------------------
Credential | DNP, APRN, FNP-C
-----------------------------------------------------
Telephone | 317-362-9737
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------