Individual
CHE PHILLMANN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1500 N RITTER AVE, INDIANAPOLIS, IN 46219-3027
(317) 355-5041
Mailing address
6626 E 75TH ST STE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004801A
IN
363LF0000X
Family Nurse Practitioner
95008674
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201214420
—
IN
Enumeration date
02/18/2014
Last updated
08/04/2022
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