Healthcare Provider Details

I. General information

NPI: 1841930468
Provider Name (Legal Business Name): KATHRYN M VROOM FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MACARTHUR BLVD STE 405
MUNSTER IN
46321-2919
US

IV. Provider business mailing address

8558 BROADWAY
MERRILLVILLE IN
46410-7032
US

V. Phone/Fax

Practice location:
  • Phone: 219-836-5167
  • Fax: 219-836-5249
Mailing address:
  • Phone: 193-927-0842
  • Fax: 219-703-6854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28191569A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71012480A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: