Provider Demographics
NPI:1689636193
Name:DANKO, LISA COLLETTE
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:COLLETTE
Last Name:DANKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 E 109TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-8693
Mailing Address - Country:US
Mailing Address - Phone:219-769-4855
Mailing Address - Fax:
Practice Address - Street 1:342 E 109TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-8693
Practice Address - Country:US
Practice Address - Phone:219-769-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN7100156A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200490390Medicaid
P91720Medicare UPIN
IN218800LMedicare ID - Type Unspecified