Healthcare Provider Details

I. General information

NPI: 1649115122
Provider Name (Legal Business Name): CARIEANN VANZUIDAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 RIDGE RD STE 7
MUNSTER IN
46321-1769
US

IV. Provider business mailing address

1127 MADISON AVE
DYER IN
46311-1408
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-9515
  • Fax: 219-237-4747
Mailing address:
  • Phone: 219-798-5521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28260005A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: