Healthcare Provider Details

I. General information

NPI: 1386174530
Provider Name (Legal Business Name): BRITTNEY BENNETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2017
Last Update Date: 09/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRANT ST
GARY IN
46402-6001
US

IV. Provider business mailing address

6280 VICTORY AVE
PORTAGE IN
46368-4530
US

V. Phone/Fax

Practice location:
  • Phone: 219-886-4000
  • Fax:
Mailing address:
  • Phone: 12193081589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF06170872
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: