Individual
MRS. CYNTHIA LYNN UTLEY-BRENEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.P.M.
Contact information
Practice address
720 S 6TH ST, MONTICELLO, IN 47960-8182
(765) 296-9842
(765) 296-9842
Mailing address
PO BOX 5134, LAFAYETTE, IN 47903-5134
(765) 426-1766
(765) 296-9842
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
07000682A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100129410A
—
IN
01
—
407560A
MEDICARE PTAN
IN
Enumeration date
02/07/2007
Last updated
08/25/2016
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