MEDICARE: SUSAN ELNORA HORN BA

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

General Provider Information

NPI Number	:	1689237851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN ELNORA HORN BA

Provider Business Mailing Address
First Line	:	1305 CUMBERLAND AVE STE 110
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1316
Country	:	US
Telephone Number	:	765-464-2991
Fax Number	:

Provider Business Practice Location Address
First Line	:	1305 CUMBERLAND AVE STE 110
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-1316
Country	:	US
Telephone Number	:	765-464-2991
Fax Number	:

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

Provider Enumeration Date	:	04/15/2019
Last Update Date	:	04/15/2019

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