Healthcare Provider Details

I. General information

NPI: 1407858046
Provider Name (Legal Business Name): BROOKE D WHITTEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE DECATUR WHITTEN DO

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22210 HINKLE RD
NOBLESVILLE IN
46062-6838
US

IV. Provider business mailing address

22210 HINKLE RD
NOBLESVILLE IN
46062-6838
US

V. Phone/Fax

Practice location:
  • Phone: 317-877-9714
  • Fax:
Mailing address:
  • Phone: 317-509-6506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02002570A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: