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NPI Code Detail

MEDICARE: ELIZABETH CLEPHANE BA,MS

MEDICARE: ELIZABETH CLEPHANE BA,MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1548889827
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH CLEPHANE BA,MS
Provider Business Mailing Address
First Line : 645 S ROGERS ST
Second Line :
City : BLOOMINGTON
State : IN
Zip : 47403-2353
Country : US
Telephone Number : 812-339-1691
Fax Number :
Provider Business Practice Location Address
First Line : 1156 OLD STATE ROAD 46
Second Line :
City : NASHVILLE
State : IN
Zip : 47448-9211
Country : US
Telephone Number : 812-988-2258
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2020
Last Update Date : 04/16/2020

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