MEDICARE: SEPTEMBER D NORTHINGTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide	24-016787-1	IN

General Provider Information

NPI Number	:	1275364523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEPTEMBER D NORTHINGTON

Provider Business Mailing Address
First Line	:	5732 MATTESON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-4150
Country	:	US
Telephone Number	:	317-695-4969
Fax Number	:

Provider Business Practice Location Address
First Line	:	5732 MATTESON DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46235-4150
Country	:	US
Telephone Number	:	317-695-4969
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2024
Last Update Date	:	08/09/2024

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