=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124387410
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CLINTON COUNTY HEALTH DEPARTMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2012
-----------------------------------------------------
Last Update Date | 09/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1234 ROSSVILLE AVE
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-659-6385
-----------------------------------------------------
Fax | 765-659-6387
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1234 ROSSVILLE AVE
-----------------------------------------------------
City | FRANKFORT
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 765-659-6385
-----------------------------------------------------
Fax | 765-659-6387
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PUBLIC HEALTH NURSE
-----------------------------------------------------
Name | MS. DANA LONGENECKER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 765-659-6385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------