Healthcare Provider Details

I. General information

NPI: 1285554287
Provider Name (Legal Business Name): DANE FIFE
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WASHINGTON ST
MARION IN
46952-3867
US

IV. Provider business mailing address

505 N WABASH AVE
MARION IN
46952-2608
US

V. Phone/Fax

Practice location:
  • Phone: 765-662-3971
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number99136976A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: