Organization
NWI PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PAULA JEAN ROUSIS RN (CEO/PRESIDENT)
(219) 794-4024
Entity
Organization
Contact information
Practice address
642 S LAKE ST, GARY, IN 46403-2967
(219) 794-4024
Mailing address
642 S LAKE ST, GARY, IN 46403-2967
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/05/2014
Last updated
10/05/2014
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