Healthcare Provider Details

I. General information

NPI: 1902059363
Provider Name (Legal Business Name): PAULINE DRANGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 LINCOLNWAY
VALPARAISO IN
48386-5727
US

IV. Provider business mailing address

607 LINCOLNWAY
VALPARAISO IN
48386-5727
US

V. Phone/Fax

Practice location:
  • Phone: 219-548-8727
  • Fax:
Mailing address:
  • Phone: 219-548-8727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number34003427A
License Number StateIN

VIII. Authorized Official

Name: MARK DRANGER
Title or Position: OFFICE MANAGER
Credential:
Phone: 219-548-8727