Provider Demographics
NPI:1730556267
Name:DARKWOOD, GERALDINE ELIZABETH (FNP)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ELIZABETH
Last Name:DARKWOOD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:1028 E WATERFORD ST STE A
Practice Address - Street 2:
Practice Address - City:WAKARUSA
Practice Address - State:IN
Practice Address - Zip Code:46573-9305
Practice Address - Country:US
Practice Address - Phone:574-862-2504
Practice Address - Fax:574-862-2505
Is Sole Proprietor?:No
Enumeration Date:2015-09-01
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005762A363LF0000X
IN28144225A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse