Provider Demographics
NPI:1609317973
Name:KLOR, CHANNAH C (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CHANNAH
Middle Name:C
Last Name:KLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 E ECKMAN ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46614-1408
Mailing Address - Country:US
Mailing Address - Phone:574-217-8089
Mailing Address - Fax:
Practice Address - Street 1:3371 W CLEVELAND ROAD EXT
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9780
Practice Address - Country:US
Practice Address - Phone:745-218-6700
Practice Address - Fax:574-218-6708
Is Sole Proprietor?:No
Enumeration Date:2017-03-20
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006969A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner