Healthcare Provider Details

I. General information

NPI: 1669049649
Provider Name (Legal Business Name): ALLISON MARIE BROCKLEY BSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALLISON MARIE SAVITSKY

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 08/24/2021
Certification Date: 08/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 N RITTER AVE STE 431
INDIANAPOLIS IN
46219-3050
US

IV. Provider business mailing address

4915 ABIGAIL DR
WESTFIELD IN
46062-9348
US

V. Phone/Fax

Practice location:
  • Phone: 317-355-9220
  • Fax: 317-355-9230
Mailing address:
  • Phone: 317-946-7362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28197769A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: