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General NPI Number Information
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NPI Number | 1881200152
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Entity Type | Organization
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Legal Business Name | POSITIVE ENERGY HEALTH CENTER LLC
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Dates
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Enumeration Date | 09/21/2020
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 5023 E 56TH ST STE 130
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1471
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Country | US
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Telephone | 317-565-7217
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Fax |
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Provider Business Mailing Address
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Address Line | 5023 E 56TH ST STE 130
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City | INDIANAPOLIS
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State | IN
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Zip | 46226-1471
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Country | US
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Telephone | 317-565-7217
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | KELLY CROWE
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Credential | NP
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Telephone | 317-565-7217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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