Individual
DIANE LYNN BRACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
9894 E 121ST ST, FISHERS, IN 46037-4154
(317) 621-4900
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
163WH0200X
Home Health Registered Nurse
28124384A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71005606A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201313080
—
IN
01
—
P01512462
RR MEDICARE
IN
Enumeration date
01/31/2015
Last updated
10/12/2023
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