Healthcare Provider Details

I. General information

NPI: 1205690195
Provider Name (Legal Business Name): BRIANNE STEFFAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2024
Last Update Date: 08/01/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1923 W GLEN PARK AVE
GRIFFITH IN
46319-3703
US

IV. Provider business mailing address

442 N CALUMET RD STE 100
CHESTERTON IN
46304-2490
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-2535
  • Fax:
Mailing address:
  • Phone: 219-281-2431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28286830A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number02003763A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71014883A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: