Basic Information
| Provider Information | |||||||||
| NPI: | 1952574394 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BHAGWANDIN | ||||||||
| FirstName: | INDIRA | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1969 WEST HART RD | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083645689 | ||||||||
| FaxNumber: | 6083645452 | ||||||||
| Practice Location | |||||||||
| Address1: | 1969 WEST HART RD | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112283 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083645689 | ||||||||
| FaxNumber: | 6083645452 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2008 | ||||||||
| LastUpdateDate: | 03/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 8397-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 163W00000X | 159448-030 | WI | N | Nursing Service Providers | Registered Nurse |
No ID Information.