Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0002X | Hospice and Palliative Medicine | 28215394A | IN |
NPI | 1174092126 |
---|---|
Provider Name | Katie O'connor |
First Address | Valparaiso, IN 46383-2508 |
Second Address | Valparaiso, IN 46383-3198 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2018 |
Last Update Date | 20/11/2018 |