Healthcare Provider Details

I. General information

NPI: 1578471629
Provider Name (Legal Business Name): ABBIE GAIL DOMINGUEZ LIM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 DON S POWERS DR
MUNSTER IN
46321-4054
US

IV. Provider business mailing address

PO BOX 84925
CHICAGO IL
60689-4925
US

V. Phone/Fax

Practice location:
  • Phone: 219-934-4200
  • Fax: 219-922-5904
Mailing address:
  • Phone: 219-934-4200
  • Fax: 219-922-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number041.490069
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.035741
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: