Individual
ELLEN N UNDERWOOD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(317) 962-0582
(317) 962-2082
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71001268A
IN
363LF0000X
Family Nurse Practitioner
Primary
71001268A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200367320
—
IN
05
—
200367320A
—
IN
01
—
233690153
MEDICARE
IN
01
—
500022895
RAIL ROAD MEDICARE
IN
Enumeration date
08/17/2005
Last updated
10/17/2022
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