Provider Demographics
NPI:1528241940
Name:FOUCH, ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:FOUCH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4949 E 246TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:IN
Mailing Address - Zip Code:46030-9668
Mailing Address - Country:US
Mailing Address - Phone:608-290-2225
Mailing Address - Fax:
Practice Address - Street 1:4949 E 246TH ST
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:IN
Practice Address - Zip Code:46030
Practice Address - Country:US
Practice Address - Phone:608-290-2225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-07
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI153707-030163W00000X
IN28204567A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI35040900Medicaid