Organization
DEACONESS CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL ANNETTE WATHEN (CFO)
(812) 450-3296
Entity
Organization
Contact information
Practice address
92 W CHRISTMAS BLVD, SANTA CLAUS, IN 47579-6044
(812) 937-4120
(812) 996-7074
Mailing address
PO BOX 631767, CINCINNATI, OH 45263-2767
(812) 450-6879
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/16/2025
Last updated
05/16/2025
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