Doctor Name: | MRS. JILL BROGDON |
NPI Number: | 1689701575 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | OTR |
License Number: | 31000073A |
Business Practice Address: | 5522 E 989 N Demotte, IN - 463108016 |
Business Phone Number: | 2197564695 |
Business Fax Number: | |
Mailing Address: | 3396 W Lakeshore Dr, CROWN POINT |
State: | IN |
Postal Code: | 463078922 |
Phone Number: | 2198983422 |
Fax Number: | |
NPI Enumeration Date: | 02/27/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 31000073A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IN |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |