Basic Information
| Provider Information | |||||||||
| NPI: | 1700260668 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BREDEWEG | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1043 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8128474481 | ||||||||
| FaxNumber: | 8128470006 | ||||||||
| Practice Location | |||||||||
| Address1: | 1216 N 1000 W | ||||||||
| Address2: | |||||||||
| City: | LINTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474415013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8126994111 | ||||||||
| FaxNumber: | 8126994497 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/10/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71005701A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.