Healthcare Provider Details

I. General information

NPI: 1912431669
Provider Name (Legal Business Name): KATHERYN PLANKENHORN WHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 04/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 W BETHEL AVE STE A ELITE HEALTHCARE OF MUNCIE INC
MUNCIE IN
47304-7504
US

IV. Provider business mailing address

3417 W BETHEL AVE STE A ELITE HEALTHCARE OF MUNCIE INC
MUNCIE IN
47304-7504
US

V. Phone/Fax

Practice location:
  • Phone: 765-281-8883
  • Fax:
Mailing address:
  • Phone: 765-281-8883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number28104916A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: