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Provider Information for 1750863841

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: FEMALE

Individual NPI: 1750863841

Calendar   Last Updated:  2018-11-23
  Certification Date: 


Name Value
NPI 1750863841
Enumeration Date 2018-09-05
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 11155 OHIO ST
CROWN POINT, IN 46307-8054
United States

Phone: 219-688-1643 | Fax:
View Map External Link
Primary Practice Address 4321 FIR ST
EAST CHICAGO, IN 46312-3049
United States

Phone: 219-392-7005 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 363LF0000X - Nurse Practitioner Family IN 71008535A
No 163W00000X - Registered Nurse IN 28198322A