1871613398 NPI number — NORTHERN INDIANA HEALTH CARE SYSTEM

Table of content: MRS. MARY JEAN EASTERWOOD RN (NPI 1760688121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871613398 NPI number — NORTHERN INDIANA HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN INDIANA HEALTH CARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871613398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 E 38TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARION
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46953-4568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-674-3321
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 E MILLER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA FONTAINE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46940-9292
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-384-5138
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
COMBS
Authorized Official First Name:
LANETTE
Authorized Official Middle Name:
LYNNE
Authorized Official Title or Position:
REGISTERED NURSE
Authorized Official Telephone Number:
765-674-3321

Provider Taxonomy Codes

  • Taxonomy code: 282E00000X , with the licence number:  074717 , 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)





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