Individual
ERIC LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
9445 CALUMET AVE, MUNSTER, IN 46321-2811
(219) 836-2055
(219) 836-0355
Mailing address
8558 BROADWAY, MERRILLVILLE, IN 46410-7032
(219) 739-2070
(219) 703-6854
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71014733A
IN
363LF0000X
Family Nurse Practitioner
F0220799
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300084066
—
IN
Enumeration date
01/05/2023
Last updated
12/12/2023
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