Healthcare Provider Details

I. General information

NPI: 1245242056
Provider Name (Legal Business Name): JAMI L KUYPER NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 04/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9034 COLUMBIA AVENUE SUITE 300
MUNSTER IN
46321
US

IV. Provider business mailing address

757 45TH STREET STE. 201
MUNSTER IN
46321
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-0296
  • Fax: 219-836-0570
Mailing address:
  • Phone: 219-922-5550
  • Fax: 219-922-5555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number041207191
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28112859A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: