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General NPI Number Information
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NPI Number | 1255897294
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Entity Type | Individual
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Provider Name | WILLETTA T GREATHOUSE
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Gender | Female
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 08/02/2021
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Provider Practice Location Address
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Address Line | 11460 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46032-4530
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Country | US
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Telephone | 178-052-3163
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Fax | 317-428-1032
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Provider Business Mailing Address
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Address Line | 11460 N MERIDIAN ST
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City | CARMEL
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State | IN
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Zip | 46032-4530
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Country | US
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Telephone | 317-805-2316
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Fax | 317-428-1032
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247200000X
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Taxonomy Name | Other Technician
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License Number |
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License Number State |
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