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Individual

MARY VATH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
9104 COLUMBIA AVE, MUNSTER, IN 46321-2907
(219) 836-4473
Mailing address
9104 COLUMBIA AVE, MUNSTER, IN 46321-2907
(219) 836-4473

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28216545A
IN
363LF0000X
Family Nurse Practitioner
Primary
71009481A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300031576
IN
Enumeration date
08/28/2019
Last updated
01/17/2020
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