Individual
MICAH DRISCOLL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
601 WALL ST, VALPARAISO, IN 46383-2512
(219) 531-3500
Mailing address
601 WALL ST, VALPARAISO, IN 46383-2512
(219) 531-3500
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28235293A
IN
163W00000X
Registered Nurse
R220189-4
MN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71014117A
IN
Other
Enumeration date
05/17/2023
Last updated
08/02/2023
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