Organization
DEACONESS CLINIC, INC
Active
Other names
Deaconess Clinic I
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL A WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
6221 PHYSICIANS CT, SUITE 1, EVANSVILLE, IN 47715-4031
(812) 479-3153
(812) 473-8166
Mailing address
PO BOX 1510, EVANSVILLE, IN 47706-1510
(812) 479-3153
(812) 473-8166
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200910700
—
IN
Enumeration date
10/25/2013
Last updated
08/10/2017
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