Healthcare Provider Details

I. General information

NPI: 1982978763
Provider Name (Legal Business Name): JENNIFER K VANMETER CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2012
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 STATE STREET
LA PORTE IN
46350-3115
US

IV. Provider business mailing address

PO BOX 1690
LA PORTE IN
46352-1690
US

V. Phone/Fax

Practice location:
  • Phone: 219-362-4690
  • Fax: 219-362-4692
Mailing address:
  • Phone: 219-326-2312
  • Fax: 219-326-2584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number28141955A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number09000217A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: