Healthcare Provider Details

I. General information

NPI: 1457057341
Provider Name (Legal Business Name): ELIZABETH M SPOLJORIC WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2023
Last Update Date: 02/02/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 STATE ST
LA PORTE IN
46350-3115
US

IV. Provider business mailing address

3145 N 400 W
LA PORTE IN
46350-8528
US

V. Phone/Fax

Practice location:
  • Phone: 219-326-0943
  • Fax:
Mailing address:
  • Phone: 219-575-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number71013549A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: