Healthcare Provider Details

I. General information

NPI: 1932483906
Provider Name (Legal Business Name): VERNEDIA SLAUGHTER ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2011
Last Update Date: 09/11/2022
Certification Date: 09/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1828 165TH ST STE A
HAMMOND IN
46320-2823
US

IV. Provider business mailing address

PO BOX 1430
PORTAGE IN
46368-9230
US

V. Phone/Fax

Practice location:
  • Phone: 219-763-8112
  • Fax: 219-884-2547
Mailing address:
  • Phone: 219-763-8112
  • Fax: 219-764-5333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209009117
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: