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NPI Code Detail

MEDICARE: BRANDY WELLS HIS

MEDICARE: BRANDY WELLS HIS
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
1237700000XHearing Instrument Specialist17001564AIN

General Provider Information

NPI Number : 1922739895
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRANDY WELLS HIS
Provider Business Mailing Address
First Line : 52 W MAIN ST STE E
Second Line :
City : DANVILLE
State : IN
Zip : 46122-1704
Country : US
Telephone Number : 317-742-0212
Fax Number :
Provider Business Practice Location Address
First Line : 52 E MAIN ST STE E
Second Line :
City : DANVILLE
State : IN
Zip : 46122-1857
Country : US
Telephone Number : 317-742-0212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2022
Last Update Date : 08/19/2022

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