Individual
MICHELLE R VASQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
820 MERIDIAN RD, VALPARAISO, IN 46385-8508
(219) 769-8340
Mailing address
820 MERIDIAN RD, VALPARAISO, IN 46385-8508
(219) 769-8340
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71003338A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200995720
—
IN
01
—
M147140039
MEDICARE PTAN
IN
01
—
P00913968
INDIVIDUAL RR MEDICARE PTAN
—
Enumeration date
07/06/2010
Last updated
12/05/2024
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