Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20043103A | IN |
Y | 103TC0700X | Clinical Psychologist | 20043103A | IN |
NPI | 1003318122 |
---|---|
Provider Name | Dr. Jean M Nanos |
First Address | Munster, IN 46321-0294 |
Second Address | Munster, IN 46321 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2018 |
Last Update Date | 07/08/2018 |