Healthcare Provider Details

I. General information

NPI: 1184862161
Provider Name (Legal Business Name): PLANNED PARENTHOOD OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2009
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3723 MAIN ST SUITE 3
EAST CHICAGO IN
46312-2978
US

IV. Provider business mailing address

3723 MAIN ST SUITE 3
EAST CHICAGO IN
46312-2978
US

V. Phone/Fax

Practice location:
  • Phone: 219-397-4071
  • Fax: 219-397-2051
Mailing address:
  • Phone: 219-397-4071
  • Fax: 219-397-2051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. MYRNA VELAZQUEZ
Title or Position: REGISTERED NURSE, MASTER'S DEGREE
Credential:
Phone: 219-397-4071