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General NPI Number Information
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NPI Number | 1952334252
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Entity Type | Organization
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Legal Business Name | WALL STREET INTERNAL MEDICINE
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 11/02/2007
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Provider Practice Location Address
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Address Line | 73 QUARTER MASTER CRT
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3759
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Country | US
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Telephone | 812-288-8360
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Fax | 812-288-8375
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Provider Business Mailing Address
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Address Line | 73 QUARTER MASTER CRT SUITE 100
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-3759
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Country | US
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Telephone | 812-288-8360
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Fax | 812-288-8375
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. CHELSEA JANE NEVITT
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Credential | M.D
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Telephone | 812-288-8360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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