Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | 71011189A | IN |
NPI | 1215504147 |
---|---|
Provider Name | Elisha Carol Trapp |
First Address | New Albany, IN 47150-6951 |
Second Address | New Albany, IN 47150-4990 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2021 |
Last Update Date | 19/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
71011189A | APRN LICENSE (01) | IN |