Individual
ELISABETH K DEGENHARDT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN
Contact information
Practice address
5230 E STOP 11 RD STE 300, INDIANAPOLIS, IN 46237-6401
(317) 781-4588
(317) 782-4885
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
70000009C
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200980490
—
IN
01
—
28089558A
RN LICENSE
IN
Enumeration date
01/07/2008
Last updated
03/07/2023
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