Provider Demographics
NPI:1366551350
Name:DETWEILER, HOWARD D (N P)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:D
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:N P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 W LONGEST ST
Mailing Address - Street 2:PO BOX 270
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-8821
Mailing Address - Country:US
Mailing Address - Phone:812-723-3944
Mailing Address - Fax:812-723-5292
Practice Address - Street 1:5604 E WHITE OAK LN
Practice Address - Street 2:
Practice Address - City:MARENGO
Practice Address - State:IN
Practice Address - Zip Code:47140-8413
Practice Address - Country:US
Practice Address - Phone:812-365-3221
Practice Address - Fax:812-365-9502
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71000802A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200000890AMedicaid
IN200000890AMedicaid
IN600340GMedicare PIN