Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 12009463A | IN |
Y | 213EG0000X | General Practice | 12009463A | IN |
NPI | 1003092305 |
---|---|
Provider Name | Dr. Jeanne Antoinette Degrazia |
First Address | Hobart, IN 46342-4151 |
Second Address | Hobart, IN 46342-4151 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2008 |
Last Update Date | 16/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200534070 | (05) | IN |