Healthcare Provider Details

I. General information

NPI: 1609269786
Provider Name (Legal Business Name): BRANDY NICOLE RAMAJ JEWETT ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRANDY NICOLE RAMAJ ATC, LAT

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 S STATE ROAD 57
WASHINGTON IN
47501-4374
US

IV. Provider business mailing address

701 CENTRAL AVE
WASHINGTON IN
47501-8537
US

V. Phone/Fax

Practice location:
  • Phone: 812-254-2203
  • Fax: 812-254-2033
Mailing address:
  • Phone: 812-584-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number36002569A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: