Provider Demographics
NPI:1891823910
Name:TIPPECANOE COUNTY AUDITOR
Entity Type:Organization
Organization Name:TIPPECANOE COUNTY AUDITOR
Other - Org Name:TIPPENCANOE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PUBLIC HEALTH NURSE
Authorized Official - Prefix:
Authorized Official - First Name:DONELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:765-423-9767
Mailing Address - Street 1:629 N 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47901-1211
Mailing Address - Country:US
Mailing Address - Phone:765-423-9222
Mailing Address - Fax:765-423-9229
Practice Address - Street 1:629 N 6TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47901-1211
Practice Address - Country:US
Practice Address - Phone:765-423-9767
Practice Address - Fax:765-423-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041733A251K00000X
251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
INTA6040Medicare ID - Type Unspecified