Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 71010539A | IN |
NPI | 1295322642 |
---|---|
Provider Name | Lauren Dandurand |
First Address | Merrillville, IN 46410-7319 |
Second Address | Merrillville, IN 46410-7319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2020 |
Last Update Date | 30/12/2020 |