Healthcare Provider Details

I. General information

NPI: 1407197346
Provider Name (Legal Business Name): KATHRYN LILLIAN TROJAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 10/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8840 CALUMET AVE SUITE 103
MUNSTER IN
46321-2545
US

IV. Provider business mailing address

8840 CALUMET AVE SUITE 103
MUNSTER IN
46321-2545
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-7246
  • Fax: 219-836-6454
Mailing address:
  • Phone: 219-836-7246
  • Fax: 219-836-6454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number71004338A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004338A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: