Individual
PROF. SHANTA BRUNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
HOME HEALTH AGENCY
Contact information
Practice address
601 S LAKE ST, GARY, IN 46403-2937
(219) 413-1220
Mailing address
601 S LAKE ST, GARY, IN 46403-2937
(219) 413-1220
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
229006
IN
Other
Enumeration date
09/22/2020
Last updated
09/22/2020
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