| NPI | 1497798284 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID BLANKENSHIP Administrative Director 574-233-1524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: IN 02001493A) |
| Additional Taxonomies | 103TH0100X Psychologist, Health Service (Licence: IN 20010221A) |
| 363L00000X Nurse Practitioner (Licence: IN 71001833A) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2012-03-22 |