Healthcare Provider Details

I. General information

NPI: 1013606011
Provider Name (Legal Business Name): DONALD ERNEST GREER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 FRANCISCAN WAY
MICHIGAN CITY IN
46360-0021
US

IV. Provider business mailing address

6220 S 775 W
SAN PIERRE IN
46374-9649
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-8511
  • Fax:
Mailing address:
  • Phone: 574-207-3072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28200905A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: