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General NPI Number Information
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NPI Number | 1346322492
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Entity Type | Organization
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Legal Business Name | FIT4DUTY LLC
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1446 GATEWAY PLZ
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4206
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Country | US
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Telephone | 812-285-1943
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Fax | 812-285-1963
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Provider Business Mailing Address
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Address Line | 1446 GATEWAY PLZ
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City | JEFFERSONVILLE
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State | IN
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Zip | 47130-4206
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Country | US
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Telephone | 812-285-1943
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Fax | 812-285-1963
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Authorized Official
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Title or Position | OWNER-PROVIDER
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Name | MRS. DENISE P BROOKS
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Credential | MSN, NP-C
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Telephone | 812-285-1943
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 71001986B
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License Number State | IN
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