Provider Demographics
NPI:1326856113
Name:BRIGHTWELL, FALISHA DEON
Entity type:Individual
Prefix:
First Name:FALISHA
Middle Name:DEON
Last Name:BRIGHTWELL
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 1:55 S STATE AVE UNIT 3111
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46201-3802
Mailing Address - Country:US
Mailing Address - Phone:317-221-9838
Mailing Address - Fax:
Practice Address - Street 1:55 S STATE AVE UNIT 3111
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46201-3802
Practice Address - Country:US
Practice Address - Phone:317-221-9838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-25
Last Update Date:2024-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN2401727313747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider