Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125:056942 | IL |
N | 111NI0900X | Internist | 125:056942 | IL |
Y | 207RR0500X | Rheumatology | 02005150A | IN |
NPI | 1053549642 |
---|---|
Provider Name | Katherine Healy Vissers Finn |
First Address | Greenwood, IN 46143-7241 |
Second Address | Munster, IN 46321-2899 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2009 |
Last Update Date | 18/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300006175 | (05) | IN |
471400487 | MEDICARE (01) | IN |