Provider Demographics
NPI:1932101573
Name:BRICKERT, TINA S (CNM)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:S
Last Name:BRICKERT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1557
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-0557
Mailing Address - Country:US
Mailing Address - Phone:765-349-4600
Mailing Address - Fax:765-349-6590
Practice Address - Street 1:2209 JOHN R WOODEN DR
Practice Address - Street 2:MORGAN OB-GYN SPECIALISTS
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1840
Practice Address - Country:US
Practice Address - Phone:765-352-9536
Practice Address - Fax:765-349-6433
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN72000016A367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1104827633OtherGROUP NPI NUMBER
IN200131150Medicaid
IN200377200Medicaid
IN191430Medicare ID - Type UnspecifiedM-CARE GROUP NUMBER
IN200377200Medicaid
IN200131150Medicaid