Individual
NICOLE BIANCA SAN JUAN LIBIRAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10684 ERIE DR, CROWN POINT, IN 46307-9454
(219) 776-3489
Mailing address
10684 ERIE DR, CROWN POINT, IN 46307-9454
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
390200000X
—
Other
Enumeration date
12/30/2024
Last updated
12/30/2024
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