Individual
THEODORE E. VANCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
1116 N 16TH ST STE A, LAFAYETTE, IN 47904-2119
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28174732A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71004543A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000829362
ANTHEM PROVIDER NUMBER
IN
05
—
201178620
—
IN
Enumeration date
05/17/2013
Last updated
03/01/2021
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