Healthcare Provider Details

I. General information

NPI: 1043891682
Provider Name (Legal Business Name): BRITTANY VOOGT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9861 LINCOLN PLAZA WAY
CEDAR LAKE IN
46303-7301
US

IV. Provider business mailing address

9861 LINCOLN PLAZA WAY
CEDAR LAKE IN
46303-7301
US

V. Phone/Fax

Practice location:
  • Phone: 219-401-8968
  • Fax: 219-401-8981
Mailing address:
  • Phone: 219-401-8968
  • Fax: 219-401-8981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28254530A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011380A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: