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NPI Code Detail

MEDICARE: MRS. DEVONA NICOLE BITHOS FNP

MEDICARE: MRS. DEVONA NICOLE BITHOS FNP
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
1363LF0000XFamily Nurse Practitioner71010951AIN

General Provider Information

NPI Number : 1760077044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEVONA NICOLE BITHOS FNP
Provider Business Mailing Address
First Line : 1481 W 10TH ST # A-6107
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-9708
Fax Number :
Provider Business Practice Location Address
First Line : 1481 W 10TH ST # A-6107
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-2803
Country : US
Telephone Number : 317-988-9708
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2021
Last Update Date : 02/16/2023

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