Healthcare Provider Details

I. General information

NPI: 1477414621
Provider Name (Legal Business Name): PERSONAL WELLNESS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2025
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2646 W LINCOLN HWY STE A
MERRILLVILLE IN
46410-5235
US

IV. Provider business mailing address

3217 W 121ST AVE
CROWN POINT IN
46307-8745
US

V. Phone/Fax

Practice location:
  • Phone: 219-444-7946
  • Fax:
Mailing address:
  • Phone: 219-444-7946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANGELA VANDERBERG
Title or Position: OWNER
Credential: FNP-BC, PMHNP-C
Phone: 219-614-9528