Basic Information
| Provider Information | |||||||||
| NPI: | 1730556267 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DARKWOOD | ||||||||
| FirstName: | GERALDINE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 N NILES AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BEND | ||||||||
| State: | IN | ||||||||
| PostalCode: | 466171924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5746471610 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1028 E WATERFORD ST STE A | ||||||||
| Address2: | |||||||||
| City: | WAKARUSA | ||||||||
| State: | IN | ||||||||
| PostalCode: | 465739305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5748622504 | ||||||||
| FaxNumber: | 5748622505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2015 | ||||||||
| LastUpdateDate: | 03/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71005762A | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163W00000X | 28144225A | IN | N | Nursing Service Providers | Registered Nurse |
No ID Information.