Individual
DIANA LOUISE BRACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
600 S JACKSON PARK DR, SEYMOUR, IN 47274-2626
(812) 519-2963
(812) 519-3515
Mailing address
600 S JACKSON PARK DR, SEYMOUR, IN 47274-2626
(812) 519-2963
(812) 519-3515
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
71001567A
IN
363LF0000X
Family Nurse Practitioner
Primary
71001567A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000652123
ANTHEM
IN
05
—
200537140
—
IN
Enumeration date
02/20/2006
Last updated
06/18/2015
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