Healthcare Provider Details

I. General information

NPI: 1114119278
Provider Name (Legal Business Name): JOLENE S. GELARDEN RN, MS, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2007
Last Update Date: 02/14/2020
Certification Date: 02/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

IV. Provider business mailing address

503 OTIS BOWEN DR
MUNSTER IN
46321-4158
US

V. Phone/Fax

Practice location:
  • Phone: 219-703-5152
  • Fax: 219-934-2044
Mailing address:
  • Phone: 219-703-5152
  • Fax: 219-934-2044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71001193A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: