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Individual

MS. BROOKE S. SOUTHERLAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
1701 N SENATE AVENUE, RM AG001, INDIANAPOLIS, IN 46202-1239
(317) 962-3886
(317) 962-8552
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001364A
IN
390200000X
Student in an Organized Health Care Education/Training Program
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000743223
ANTHEM PIN
IN
Enumeration date
07/04/2011
Last updated
02/18/2021
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