Healthcare Provider Details

I. General information

NPI: 1871460931
Provider Name (Legal Business Name): RYAN SMOTHERS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2025
Last Update Date: 10/22/2025
Certification Date: 10/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8135 CALUMET AVE
MUNSTER IN
46321-1701
US

IV. Provider business mailing address

901 HAYES ST
CROWN POINT IN
46307-5017
US

V. Phone/Fax

Practice location:
  • Phone: 219-513-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF10250667
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: