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General NPI Number Information
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NPI Number | 1619744133
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Entity Type | Individual
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Provider Name | BRITTANY MEDLEY NP
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Gender | Female
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Dates
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Enumeration Date | 12/05/2023
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 5905 W 122ND PL
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City | CROWN POINT
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State | IN
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Zip | 46307-8741
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Country | US
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Telephone | 121-967-1456
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Fax |
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Provider Business Mailing Address
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Address Line | 250 N MAIN ST
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City | CROWN POINT
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State | IN
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Zip | 46307-3278
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Country | US
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Telephone | 219-671-4562
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Fax |
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 71014670A
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License Number State | IN
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