Organization
LUXE LIFE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH VICTORIA MOERMAN FNP (OWNER/FNP)
(219) 247-4003
Entity
Organization
Contact information
Practice address
606 LINCOLNWAY, VALPARAISO, IN 46383-5728
(219) 247-4003
Mailing address
606 LINCOLNWAY, VALPARAISO, IN 46383-5728
(219) 247-4003
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300032267
—
IN
01
—
IN4530
IN MEDICARE
IN
Enumeration date
12/07/2020
Last updated
09/06/2023
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