Doctor Name: | HOWARD D DETWEILER |
NPI Number: | 1366551350 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | N. P. |
License Number: | 71000802A |
Business Practice Address: | 5604 E White Oak Ln Marengo, IN - 471408413 |
Business Phone Number: | 8123653221 |
Business Fax Number: | 8123659502 |
Mailing Address: | 420 W Longest St, Po Box 270 PAOLI |
State: | IN |
Postal Code: | 474548821 |
Phone Number: | 8127233944 |
Fax Number: | 8127235292 |
NPI Enumeration Date: | 08/30/2006 |
NPI Last Update Date: | 06/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 71000802A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |