Provider Demographics
NPI:1801846175
Name:ANCICH, BRIANNE ELIZABETH (PA)
Entity Type:Individual
Prefix:MISS
First Name:BRIANNE
Middle Name:ELIZABETH
Last Name:ANCICH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1260 INNOVATION PKWY
Mailing Address - Street 2:#100
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-3602
Mailing Address - Country:US
Mailing Address - Phone:317-884-5200
Mailing Address - Fax:317-884-5360
Practice Address - Street 1:1260 INNOVATION PKWY
Practice Address - Street 2:#100
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-3602
Practice Address - Country:US
Practice Address - Phone:317-884-5200
Practice Address - Fax:317-884-5360
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN10000819A363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN037170I6Medicare ID - Type Unspecified
INQ65548Medicare UPIN