Provider Demographics
NPI:1477556108
Name:FILLENWARTH, GREG ANDREW (FNP,BC)
Entity Type:Individual
Prefix:MR
First Name:GREG
Middle Name:ANDREW
Last Name:FILLENWARTH
Suffix:
Gender:M
Credentials:FNP,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 COMMERCIAL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH VERNON
Mailing Address - State:IN
Mailing Address - Zip Code:47265-5547
Mailing Address - Country:US
Mailing Address - Phone:812-953-1348
Mailing Address - Fax:812-953-1356
Practice Address - Street 1:1800 COMMERCIAL DR
Practice Address - Street 2:
Practice Address - City:NORTH VERNON
Practice Address - State:IN
Practice Address - Zip Code:47265-5547
Practice Address - Country:US
Practice Address - Phone:812-953-1348
Practice Address - Fax:812-953-1356
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001766B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200519260Medicaid
IN200519260Medicaid
IN232230BBBBMedicare UPIN
IN153862Medicare Oscar/Certification