MEDICARE: WINONA BENITA PITTS NP

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	363LA2200X	Adult Health Nurse Practitioner	28201413A	IN

General Provider Information

NPI Number	:	1912485038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WINONA BENITA PITTS NP

Provider Business Mailing Address
First Line	:	484 E CARMEL DR
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-2812
Country	:	US
Telephone Number	:	317-660-1379
Fax Number	:

Provider Business Practice Location Address
First Line	:	3851 N RIVER RD
Second Line	:
City	:	WEST LAFAYETTE
State	:	IN
Zip	:	47906-3765
Country	:	US
Telephone Number	:	765-463-1502
Fax Number	:

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

Provider Enumeration Date	:	07/31/2018
Last Update Date	:	07/31/2018

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