Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 28147845 | IN |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 71002211A | IN |
NPI | 1073687653 |
---|---|
Provider Name | Brandi L Vandivier |
First Address | Indianapolis, IN 46206-1026 |
Second Address | Indianapolis, IN 46202-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/11/2006 |
Last Update Date | 14/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000618963 | ANTHEM PROVIDER NUMBER (01) | IN |
200908180 | (05) | IN |