Healthcare Provider Details

I. General information

NPI: 1679508410
Provider Name (Legal Business Name): MARIANNE K SCHALLMO ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 01/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8895 BROADWAY
MERRILLVILLE IN
46410-7037
US

IV. Provider business mailing address

8895 BROADWAY
MERRILLVILLE IN
46410-7037
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-2081
  • Fax: 219-736-4658
Mailing address:
  • Phone: 219-738-2081
  • Fax: 219-736-4658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28115564A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number28115564A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: