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General NPI Number Information
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NPI Number | 1962772905
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Entity Type | Organization
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Legal Business Name | INDIANA UNIVERSITY HEALTH, INC
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Dates
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Enumeration Date | 01/09/2012
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 705 RILEY HOSPITAL DR SUITE 1960
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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 | 317-374-8331
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Fax | 317-944-3939
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Provider Business Mailing Address
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Address Line | 705 RILEY HOSPITAL DR SUITE 1960
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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 | 317-374-8331
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Fax | 317-944-3939
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Authorized Official
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Title or Position | PEDIATRIC NURSE PRACTITIONER
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Name | MRS. JENNIFER ANN GROSSI
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Credential | CPNP
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Telephone | 317-374-8331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 281PC2000X
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Taxonomy Name | Children's Chronic Disease Hospital
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License Number | 71003801A
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License Number State | IN
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