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General NPI Number Information
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NPI Number | 1699556746
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE HEALTHCARE LLC
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Dates
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Enumeration Date | 10/12/2023
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 4595 WALNUT RD STE L
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City | BUCKEYE LAKE
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State | OH
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Zip | 43008-7909
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Country | US
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Telephone | 740-822-0080
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Fax | 740-822-0081
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Provider Business Mailing Address
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Address Line | 4595 WALNUT RD STE L
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City | BUCKEYE LAKE
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State | OH
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Zip | 43008-7909
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Country | US
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Telephone | 740-822-0080
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Fax | 740-822-0081
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | KHADIE MURIEL THOMAS
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Credential | DNP, FNP-BC
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Telephone | 614-893-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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