Diabetes Association of St Joseph County Inc

Primary specialty

Diabetes Educator Registered NurseTaxonomy code 163WD0400X

License

28071850A Issued in IN

Legal business name

DIABETES ASSOCIATION OF ST JOSEPH COUNTY INC

Practice address

6910 North Main St
Building 9
Granger, IN 46530

Phone

(574) 247-6047

Fax

(574) 247-6060

NPI assigned

Aug 5, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Bonita A Raine, PH.D.

Title

Executive Director

Phone

(574) 247-6047

Specialties & licenses 1

Addresses

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Meg T. Brewer, M.A.

  • Speech-Language Pathologist
  • Granger, IN
  • NPI 1407067390
  NPD (past)
• Mary Jo Canaday, M.S., CCC-A/SP

  • Audiologist-Hearing Aid Fitter
  • Granger, IN
  • NPI 1659536415
  NPD (past)
• Elizabeth K. Ready, M.A.

  • Speech-Language Pathologist
  • Granger, IN
  • NPI 1194936997
  NPD (past)
• Rhonda M. Tomenko, PH.D.

  • Audiologist-Hearing Aid Fitter
  • Granger, IN
  • NPI 1306057922
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186272000000",
    "number": "1235320540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6910 NORTH MAIN STREET",
            "address_2": "BLDG. 9, MAIL UNIT #10",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "46530",
            "telephone_number": "574-247-6047",
            "fax_number": "547-247-6060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6910 NORTH MAIN ST",
            "address_2": "BUILDING 9",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "46530",
            "telephone_number": "574-247-6047",
            "fax_number": "574-247-6060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIABETES ASSOCIATION OF ST JOSEPH COUNTY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2007-08-05",
        "status": "A",
        "authorized_official_last_name": "RAINE",
        "authorized_official_first_name": "BONITA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "574-247-6047",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "163WD0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Diabetes Educator",
            "state": "IN",
            "license": "28071850A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna K Detlefsen, LCSW
• Gabriel Detweiler
• Sharon E Devinney, PH.D., HSPP
• Michael Dewit, OD
• Julie Batuk Dharia, OD
• Michelle Dies, PHARM D
• Woganee Mimi Dires, PHARMD
• Mary Ann R Domingo, M.D.
• Dr Kevin D Hancock PC
• Tamara Lynn Duchine, RPH

• All providers in Granger, IN
• Diabetes Educator Registered Nurse in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.