1275106288 NPI number — MRS. KATLYN DANIELLE CORPE FAMILY NP

Table of content: MRS. KATLYN DANIELLE CORPE FAMILY NP (NPI 1275106288)

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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