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General NPI Number Information
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NPI Number | 1639234974
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Entity Type | Individual
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Provider Name | SUSAN JANE MACGILVRAY NP
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Gender | Female
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Dates
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Enumeration Date | 12/27/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 NEELEY AVE BALL STATE UNIVERSITY STUDENT HEALTH CENTER
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City | MUNCIE
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State | IN
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Zip | 47306-0001
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Country | US
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Telephone | 765-285-1254
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Fax | 765-285-3512
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Provider Business Mailing Address
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Address Line | 2328 STARLIGHT DR
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City | ANDERSON
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State | IN
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Zip | 46012-1946
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 71000445A
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License Number State | IN
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