Healthcare Provider Details

I. General information

NPI: 1780097014
Provider Name (Legal Business Name): PATRICIA E O'HALLORAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PATRICA E INVERGO

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MACARTHUR BLVD AUDIOLOGY DEPARTMENT
MUNSTER IN
46321-2901
US

IV. Provider business mailing address

1500 S LAKE PARK AVE MANAGED CARE DEPARTMENT
HOBART IN
46342-6638
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-1600
  • Fax:
Mailing address:
  • Phone: 219-947-6113
  • Fax: 219-947-6503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002073A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: