Brackett, Dana G.
Brackett, Dana G. is an individual health care provider with primary practice located at 53880 Carmichael Dr , South Bend IN 46635-1567. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Brackett, Dana G. can be contacted via phone (574) 247-9441.Contact Information
Primary practice address
53880 Carmichael Dr
South Bend IN 46635-1567
Phone: (574) 247-9441
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 71002064A | Indiana |
Profile Details
| NPI number | 1164499067 |
|---|---|
| LBN Legal business name | Brackett, Dana G. |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 1st, 2006 |
| Last updated | Nov 8th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1164499067 | NPPES |
| Indiana | MEDICAID | 200808410 |
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