Individual
JESSICA VAN NOORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6831 W 133RD AVE, CEDAR LAKE, IN 46303-8989
(219) 374-5970
(219) 374-7505
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71010720A
IN
363LP2300X
Primary Care Nurse Practitioner
71010720A
IN
Other
Enumeration date
01/11/2021
Last updated
10/06/2023
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