| Organization Name: | DIABETES ASSOCIATION OF ST JOSEPH COUNTY INC |
| NPI Number: | 1235320540 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BONITA A RAINE (EXECUTIVE DIRECTOR) |
| Mailing Address: | 6910 North Main St Building 9 Granger |
| State: | IN US |
| Postal Code: | 46530 |
| Phone Number: | 5742476047 |
| Fax Number: | 5742476060 |
| NPI Enumeration Date: | 08/05/2007 |
| NPI Last Update Date: | 08/05/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WD0400X |
| License Number: | 28071850A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Diabetes Educator |
| Taxonomy Definition: | |