1215394507 NPI number — MRS. BRITTANY WITHROW NNP

Table of content: MRS. BRITTANY WITHROW NNP (NPI 1215394507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215394507 NPI number — MRS. BRITTANY WITHROW NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WITHROW
Provider First Name:
BRITTANY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
NNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215394507
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 ESKENAZI AVE
Provider Second Line Business Mailing Address:
FIFTH THIRD BANK BLDG, 5TH FL
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46202-5166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-880-4121
Provider Business Mailing Address Fax Number:
317-880-0343

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 ESKENAZI AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46202-5166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-880-7666
Provider Business Practice Location Address Fax Number:
317-880-0448
Provider Enumeration Date:
01/19/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LN0000X , with the licence number:  28191824A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com