Healthcare Provider Details

I. General information

NPI: 1053286773
Provider Name (Legal Business Name): ERICA ORTEGA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MACARTHUR BLVD STE 29
MUNSTER IN
46321-2917
US

IV. Provider business mailing address

13610 FREEDOM WAY
CEDAR LAKE IN
46303-0838
US

V. Phone/Fax

Practice location:
  • Phone: 219-378-8872
  • Fax:
Mailing address:
  • Phone: 219-378-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71018214A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: