Individual
SHAN LI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 N MAIN ST # 304, CROWN POINT, IN 46307-1877
(574) 546-1900
(574) 546-1999
Mailing address
5508 AGAPE LN, VALPARAISO, IN 46383-1206
(219) 510-3316
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28248448A
IN
363LG0600X
Gerontology Nurse Practitioner
Primary
71015549A
IN
Other
Enumeration date
06/21/2024
Last updated
07/31/2024
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