Provider Demographics
NPI:1275364523
Name:NORTHINGTON, SEPTEMBER D
Entity type:Individual
Prefix:
First Name:SEPTEMBER
Middle Name:D
Last Name:NORTHINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5732 MATTESON DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-4150
Mailing Address - Country:US
Mailing Address - Phone:317-695-4969
Mailing Address - Fax:
Practice Address - Street 1:5732 MATTESON DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46235-4150
Practice Address - Country:US
Practice Address - Phone:317-695-4969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN24-016787-1374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide