MEDICARE: DAVID GERARD VANREMORTEL ANP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	28139858A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	28139858A	OTHER	IN	INDIANA NURSING LICENSE NUMBER

General Provider Information

NPI Number	:	1548547490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID GERARD VANREMORTEL ANP-BC

Provider Business Mailing Address
First Line	:	2085 ACORN BLVD
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-7306
Country	:	US
Telephone Number	:	317-346-2273
Fax Number	:	317-738-7850

Provider Business Practice Location Address
First Line	:	2085 ACORN BLVD
Second Line	:
City	:	FRANKLIN
State	:	IN
Zip	:	46131-7306
Country	:	US
Telephone Number	:	317-346-2273
Fax Number	:	317-738-7850

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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