MEDICARE: CONNIE J RAMIREZ NP

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	363LF0000X	Family Nurse Practitioner	71000714	IN
2	363LF0000X	Family Nurse Practitioner	71000714A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000489424	OTHER	IN	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000000489424	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1770657959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CONNIE J RAMIREZ NP

Provider Business Mailing Address
First Line	:	505 WEST US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-3311
Fax Number	:	219-322-8210

Provider Business Practice Location Address
First Line	:	505 WEST US HIGHWAY 30
Second Line	:
City	:	SCHERERVILLE
State	:	IN
Zip	:	46375-2650
Country	:	US
Telephone Number	:	219-322-3311
Fax Number	:	219-322-8210

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	03/10/2011

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Directions to “ CONNIE J RAMIREZ NP” Practice Location

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