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General NPI Number Information
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NPI Number | 1104973536
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Entity Type | Individual
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Provider Name | ELIZABETH DIANE SCHALLIOL N.P.
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Gender | Female
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 100 NAVARRE PL STE 4470
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City | SOUTH BEND
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State | IN
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Zip | 46601-1168
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Country | US
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Telephone | 574-647-1405
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Fax | 574-647-3970
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Provider Business Mailing Address
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Address Line | 3245 HEALTH DR STE 100
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City | GRANGER
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State | IN
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Zip | 46530-1380
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Country | US
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Telephone | 574-647-2129
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Fax | 574-237-6069
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 71002043A
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License Number State | IN
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