Healthcare Provider Details

I. General information

NPI: 1760429336
Provider Name (Legal Business Name): NANCY M WHITE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NANCY M PALKA NP

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E 89TH AVE
MERRILLVILLE IN
46410-7318
US

IV. Provider business mailing address

200 E 89TH AVE
MERRILLVILLE IN
46410-7318
US

V. Phone/Fax

Practice location:
  • Phone: 219-738-4926
  • Fax: 219-738-4931
Mailing address:
  • Phone: 219-738-4926
  • Fax: 219-738-4931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71001920A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: