Provider Demographics
NPI:1225876253
Name:BELL, ELIZABETH (MD STUDENT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:MD STUDENT
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:BELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:675 PEBBLE BEACH DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9237
Mailing Address - Country:US
Mailing Address - Phone:812-309-9914
Mailing Address - Fax:
Practice Address - Street 1:675 PEBBLE BEACH DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9237
Practice Address - Country:US
Practice Address - Phone:812-309-9914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program