Healthcare Provider Details

I. General information

NPI: 1396344487
Provider Name (Legal Business Name): DANIEL COLE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FRANCISCAN WAY
MICHIGAN CITY IN
46360-0021
US

IV. Provider business mailing address

5213 W 400 S
LA PORTE IN
46350-9535
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-8511
  • Fax:
Mailing address:
  • Phone: 219-363-4659
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71010468A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: