1275106288 NPI number — MRS. KATLYN DANIELLE CORPE FAMILY NP

Table of content: LEO M FARBOTA MD (NPI 1982665196)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275106288 NPI number — MRS. KATLYN DANIELLE CORPE FAMILY NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CORPE
Provider First Name:
KATLYN
Provider Middle Name:
DANIELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FAMILY NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSINSKI
Provider Other First Name:
KATLYN
Provider Other Middle Name:
DANIELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1275106288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2316 NUTTMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WAYNE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46809-1202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
260-409-3997
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 S MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47305-2465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-286-7000
Provider Business Practice Location Address Fax Number:
765-213-2769
Provider Enumeration Date:
07/19/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  28235248A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 28235248A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F05210566 . This is a "FAMILY NURSE PRACTITIONER CERTIFICATION" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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