Provider Demographics
NPI:1104973536
Name:SCHALLIOL, ELIZABETH DIANE (NP)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:DIANE
Last Name:SCHALLIOL
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:574-647-2129
Mailing Address - Fax:574-237-6069
Practice Address - Street 1:100 NAVARRE PL STE 4470
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1168
Practice Address - Country:US
Practice Address - Phone:574-647-1405
Practice Address - Fax:574-647-3970
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71002043A363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200866450Medicaid
IN261970041Medicare PIN