Healthcare Provider Details

I. General information

NPI: 1922192269
Provider Name (Legal Business Name): BRENDA DANGLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/29/2022
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9805 GEIST CROSSING DR
INDIANAPOLIS IN
46256-4819
US

IV. Provider business mailing address

1717 CHAPMAN DR
GREENFIELD IN
46140-2528
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-1353
  • Fax:
Mailing address:
  • Phone: 317-694-6784
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001684
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: