1578607834 NPI number — MRS. NATALIE MARTHA GRANTNER MSW

Table of content: MRS. NATALIE MARTHA GRANTNER MSW (NPI 1578607834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578607834 NPI number — MRS. NATALIE MARTHA GRANTNER MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRANTNER
Provider First Name:
NATALIE
Provider Middle Name:
MARTHA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAPIRO
Provider Other First Name:
NATALIE
Provider Other Middle Name:
MARTHA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578607834
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4809 EAST 117TH AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CROWN POINT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46307-8610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-805-9555
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9111 BROADWAY STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MERRILLVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46410-7092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-281-2335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/19/2007

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: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 34007382A , 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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