Healthcare Provider Details

I. General information

NPI: 1558945378
Provider Name (Legal Business Name): MRS. MELISSA DIANE OSEGUERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6195 MARCELLA BLVD
HOBART IN
46342-0040
US

IV. Provider business mailing address

17 DEERPATH RD
MERRILLVILLE IN
46410-4706
US

V. Phone/Fax

Practice location:
  • Phone: 219-942-7100
  • Fax:
Mailing address:
  • Phone: 219-775-1553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011114A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: