Individual
EVELIN KEULTJES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1815 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 647-1700
Mailing address
12015 PEACOCK CIR, GRANGER, IN 46530-9511
(574) 276-8690
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
28216118A
IN
363LF0000X
Family Nurse Practitioner
Primary
71009377A
IN
Other
Enumeration date
08/26/2019
Last updated
10/31/2024
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