Provider Demographics
NPI:1952778052
Name:LOPILATO, BRANDY (APN)
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:
Last Name:LOPILATO
Suffix:
Gender:
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 W MEMORIAL DR # 2071
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47302-7632
Mailing Address - Country:US
Mailing Address - Phone:765-760-2927
Mailing Address - Fax:765-372-5596
Practice Address - Street 1:1601 W CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47302-8697
Practice Address - Country:US
Practice Address - Phone:765-760-2927
Practice Address - Fax:765-372-5596
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005833A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201324400Medicaid
ININ2609017OtherMEDICARE