Organization
LAKE EFFECT HEALING PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER EVANS MS, FNP-BC, PMHNP-BC (NURSE PRACTITIONER)
(219) 210-8331
Entity
Organization
Contact information
Practice address
613 FRANKLIN ST STE C, MICHIGAN CITY, IN 46360-3411
(317) 449-9669
(888) 915-0644
Mailing address
613 FRANKLIN ST, MICHIGAN CITY, IN 46360-3411
(219) 210-8331
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
04/17/2023
Last updated
04/17/2023
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