# DEACONESS CLINIC INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386435428
- **Authorized official:** CHERYL ANNETTE WATHEN (CFO)
- **Authorized official phone:** (812) 450-3296

## Contact information

- **Practice address:** 303 N MERIDIAN ST, HOLLAND, IN 47541-9656
- **Practice address phone:** (812) 536-3943
- **Practice address fax:** (812) 777-4863
- **Mailing address:** PO BOX 631767, CINCINNATI, OH 45263-2767
- **Mailing address phone:** (812) 450-6879

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/16/2025
- **Last updated:** 05/16/2025