1669049649 NPI number — ALLISON MARIE BROCKLEY BSN, APRN, FNP-C

Table of content: ALLISON MARIE BROCKLEY BSN, APRN, FNP-C (NPI 1669049649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669049649 NPI number — ALLISON MARIE BROCKLEY BSN, APRN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROCKLEY
Provider First Name:
ALLISON
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, APRN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAVITSKY
Provider Other First Name:
ALLISON
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1669049649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4915 ABIGAIL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESTFIELD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46062-9348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-946-7362
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 N RITTER AVE STE 431
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:
46219-3050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-355-9220
Provider Business Practice Location Address Fax Number:
317-355-9230
Provider Enumeration Date:
06/08/2021

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: 363LF0000X , with the licence number:  28197769A , 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)

  • Identifier: 300053617 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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