=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174364426
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOSHUA GEIBE PMHNP-BC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/03/2024
-----------------------------------------------------
Last Update Date | 06/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 MACARTHUR BLVD STE 5
-----------------------------------------------------
City | MUNSTER
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46321-2917
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 219-703-2485
-----------------------------------------------------
Fax | 219-703-6894
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8558 BROADWAY
-----------------------------------------------------
City | MERRILLVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46410-7032
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 193-927-0842
-----------------------------------------------------
Fax | 219-703-6854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 71015352A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------