Healthcare Provider Details

I. General information

NPI: 1689042012
Provider Name (Legal Business Name): TERESA S PARKHOUSE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 I ST
LA PORTE IN
46350-5533
US

IV. Provider business mailing address

710 N NILES AVE
SOUTH BEND IN
46617-1924
US

V. Phone/Fax

Practice location:
  • Phone: 219-324-1700
  • Fax:
Mailing address:
  • Phone: 574-647-1610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71005797A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: