Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 71010720A | IN |
NPI | 1043809429 |
---|---|
Provider Name | Jessica Van Noort |
First Address | Merrillville, IN 46410-5912 |
Second Address | Merrillville, IN 46410-5912 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2021 |
Last Update Date | 31/08/2021 |