MEDICARE: LACHARITY EUGENIA FAYE UZZELL M.S. ED

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
1	171M00000X	Case Manager/Care Coordinator
2	172A00000X	Driver

General Provider Information

NPI Number	:	1669036927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LACHARITY EUGENIA FAYE UZZELL M.S. ED

Provider Business Mailing Address
First Line	:	2245 GRAND PRIX DR APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-4373
Country	:	US
Telephone Number	:	317-593-5813
Fax Number	:

Provider Business Practice Location Address
First Line	:	2245 GRAND PRIX DR APT B
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46224-4373
Country	:	US
Telephone Number	:	317-593-5813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2019
Last Update Date	:	04/23/2019

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