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General NPI Number Information
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NPI Number | 1730600784
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Entity Type | Individual
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Provider Name | EVANGELINE CLAIRE KURTZ-NELSON
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Gender | Female
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Dates
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Enumeration Date | 06/29/2017
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 705 RILEY HOSPITAL DR
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5109
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Country | US
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Telephone | 317-944-4842
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 778912
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City | CHICAGO
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State | IL
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Zip | 60677-8912
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Country | US
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Telephone | 317-777-6435
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20043564B
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License Number State | IN
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