Provider Demographics
NPI:1790545432
Name:PROHEALTH PROVIDERS PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:PROHEALTH PROVIDERS PSYCHIATRIC SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CHENAI
Authorized Official - Middle Name:
Authorized Official - Last Name:MVUNDURA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:317-268-2199
Mailing Address - Street 1:230 S PERRY RD STE 1079
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46168-2735
Mailing Address - Country:US
Mailing Address - Phone:317-268-2199
Mailing Address - Fax:
Practice Address - Street 1:7365 E 16TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2308
Practice Address - Country:US
Practice Address - Phone:317-268-2199
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty