Healthcare Provider Details

I. General information

NPI: 1184071235
Provider Name (Legal Business Name): DEANN BERETTA DAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2016
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6448 PARK CENTRAL WAY APT D
INDIANAPOLIS IN
46260-4525
US

IV. Provider business mailing address

6448 PARK CENTRAL WAY APT D
INDIANAPOLIS IN
46260-4525
US

V. Phone/Fax

Practice location:
  • Phone: 317-979-0316
  • Fax:
Mailing address:
  • Phone: 317-979-0316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: