Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 71001257A | IN |
NPI | 1023087913 |
---|---|
Provider Name | Mrs. Josefina Estrada Offredo |
First Address | Crown Point, IN 46307-8602 |
Second Address | Crown Point, IN 46307-8602 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 12/07/2007 |