Healthcare Provider Details

I. General information

NPI: 1619301181
Provider Name (Legal Business Name): JASON AARON BITTNER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2013
Last Update Date: 09/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1481 W 10TH ST
INDIANAPOLIS IN
46202-2803
US

IV. Provider business mailing address

5916 BASTILLE LN
INDIANAPOLIS IN
46254-5165
US

V. Phone/Fax

Practice location:
  • Phone: 317-988-4198
  • Fax:
Mailing address:
  • Phone: 317-408-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number28181538A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: