Individual
MR. PHILLIP T DETURK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
124 SAGAMORE PKWY WEST, WEST LAFAYETTE, IN 47906
(765) 463-6722
(765) 463-0905
Mailing address
124 SAGAMORE PKWY WEST, WEST LAFAYETTE, IN 47906
(765) 463-6722
(765) 463-0905
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71002161A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28153076A
REGISTERED NURSE LICENSE
IN
01
—
71002161A
NURSE PRACTITIONER AUTHOR
IN
01
—
71002161B
APN CSR REFERENCE
IN
Enumeration date
10/02/2006
Last updated
12/19/2024
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