Provider Demographics
NPI:1386924447
Name:INDIANA UNIVERSITY HEALTH
Entity type:Organization
Organization Name:INDIANA UNIVERSITY HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:N
Authorized Official - Last Name:YOO
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN,CPNP
Authorized Official - Phone:219-808-3680
Mailing Address - Street 1:702 BARNHILL DR
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5128
Mailing Address - Country:US
Mailing Address - Phone:317-948-4949
Mailing Address - Fax:
Practice Address - Street 1:702 BARNHILL DR
Practice Address - Street 2:SUITE 2500
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5128
Practice Address - Country:US
Practice Address - Phone:317-948-4949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28170497A282NC2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN71003737BMedicaid
IN71003737AMedicaid