Doctor Name: | MR. GREG ANDREW FILLENWARTH |
NPI Number: | 1477556108 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP,BC |
License Number: | 71001766B |
Business Practice Address: | 1190 W Main St Suite 300 Vevay, IN - 470433639 |
Business Phone Number: | 8124274038 |
Business Fax Number: | 8124273246 |
Mailing Address: | 1190 W Main St, Suite 300 VEVAY |
State: | IN |
Postal Code: | 470433639 |
Phone Number: | 8124274038 |
Fax Number: | 8124273246 |
NPI Enumeration Date: | 05/27/2005 |
NPI Last Update Date: | 06/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 71001766B |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |