Provider Demographics
NPI:1740696467
Name:PHILIPOSE, ANNA
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:PHILIPOSE
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 1:2401 VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-2520
Mailing Address - Country:US
Mailing Address - Phone:219-413-5100
Mailing Address - Fax:
Practice Address - Street 1:2401 VALLEY DR
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2520
Practice Address - Country:US
Practice Address - Phone:219-413-5100
Practice Address - Fax:219-465-9502
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71004951B363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health