Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 71005207A | IN |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 71005207A | IN |
NPI | 1518369883 |
---|---|
Provider Name | Rebecca Sue Herrold-Engstrom |
First Address | Valparaiso, IN 46383-3769 |
Second Address | Valparaiso, IN 46383 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2014 |
Last Update Date | 27/07/2018 |