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General NPI Number Information
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NPI Number | 1972354991
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Entity Type | Individual
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Provider Name | DARLA MARIE MCLAURIN
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Gender | Female
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Dates
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Enumeration Date | 03/28/2024
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Last Update Date | 03/28/2024
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Provider Practice Location Address
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Address Line | 5454 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1648
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Country | US
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Telephone | 219-290-7776
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Fax |
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Provider Business Mailing Address
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Address Line | 5454 BROADWAY
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City | MERRILLVILLE
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State | IN
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Zip | 46410-1648
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Country | US
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Telephone | 219-702-6283
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | BC21402302
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License Number State | IN
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