Healthcare Provider Details

I. General information

NPI: 1609438910
Provider Name (Legal Business Name): MA CARMEL QUIJADA BREIDIGAN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MA CARMEL ANTONIO NP

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 05/05/2021
Certification Date: 04/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

IV. Provider business mailing address

601 GATEWAY BLVD N
CHESTERTON IN
46304-9658
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-1444
  • Fax: 219-921-5303
Mailing address:
  • Phone: 219-921-1444
  • Fax: 219-921-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28226979
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number710009280A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: