MEDICARE: GENEVA HEATH RN, FNP

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	363LF0000X	Family Nurse Practitioner	28188352A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811599533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GENEVA HEATH RN, FNP

Provider Business Mailing Address
First Line	:	8201 W WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46231-1346
Country	:	US
Telephone Number	:	317-244-6848
Fax Number	:

Provider Business Practice Location Address
First Line	:	8201 W WASHINGTON ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46231-1346
Country	:	US
Telephone Number	:	317-244-6848
Fax Number	:

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

Provider Enumeration Date	:	11/09/2020
Last Update Date	:	11/11/2020

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