Healthcare Provider Details

I. General information

NPI: 1225348733
Provider Name (Legal Business Name): LAPORTE REGIONAL PHYSICIAN NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2010
Last Update Date: 10/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W KIEFFER RD
MICHIGAN CITY IN
46360-9599
US

IV. Provider business mailing address

1100 LINCOLNWAY
LA PORTE IN
46352
US

V. Phone/Fax

Practice location:
  • Phone: 219-879-6262
  • Fax: 219-874-1885
Mailing address:
  • Phone: 219-326-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71003388
License Number StateIN

VIII. Authorized Official

Name: RHONDA VOLK
Title or Position: EXECUTIVE VICE-PRESIDENT
Credential:
Phone: 219-326-2489