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General NPI Number Information
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NPI Number | 1891497590
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Entity Type | Organization
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Legal Business Name | ELEVATE CARE CLINIC LLC
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 503 W NATIONAL AVE
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City | BRAZIL
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State | IN
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Zip | 47834-2502
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Country | US
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Telephone | 812-251-4873
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Fax |
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Provider Business Mailing Address
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Address Line | 4160 N PRIVATE ROAD 220 E
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City | BRAZIL
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State | IN
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Zip | 47834-8354
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Country | US
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Telephone | 812-251-4873
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAITLYN NEVILL
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Credential | FNP-C
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Telephone | 812-251-4873
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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