Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 01069495A | IN |
NPI | 1144310970 |
---|---|
Provider Name | Renee L Bartlett |
First Address | Vincennes, IN 47591-1038 |
Second Address | Vincennes, IN 47591-1038 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 07/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000712643 | ANTHEM (01) | IN |
100189710B | (05) | KS |
201020990 | (05) | IN |
G33572 | (02) |