Healthcare Provider Details

I. General information

NPI: 1841672284
Provider Name (Legal Business Name): THE LUTHERAN UNIVERSITY ASSOCIATION INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 06/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 UNIVERSITY DR SUITE #102
VALPARAISO IN
46383-2195
US

IV. Provider business mailing address

1700 CHAPEL DR
VALPARAISO IN
46383-4520
US

V. Phone/Fax

Practice location:
  • Phone: 219-464-5060
  • Fax: 219-464-5410
Mailing address:
  • Phone: 219-464-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KELLEY ESHENAUR
Title or Position: HEALTH CENTER DIRECTOR
Credential: FNP-C
Phone: 219-464-5352