Healthcare Provider Details

I. General information

NPI: 1720820566
Provider Name (Legal Business Name): ERENDIRA BERNAL ODLE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 CALUMET AVE
MUNSTER IN
46321-4055
US

IV. Provider business mailing address

10244 NICKLAUS ST
CROWN POINT IN
46307-7666
US

V. Phone/Fax

Practice location:
  • Phone: 219-227-5119
  • Fax: 219-227-5190
Mailing address:
  • Phone: 219-973-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF03240871
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: