Healthcare Provider Details

I. General information

NPI: 1508830613
Provider Name (Legal Business Name): MELANIE A PERGIEL ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 04/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 WALL ST
VALPARAISO IN
46383-2514
US

IV. Provider business mailing address

701 WALL ST
VALPARAISO IN
46383-2514
US

V. Phone/Fax

Practice location:
  • Phone: 219-413-5100
  • Fax: 219-465-9502
Mailing address:
  • Phone: 219-413-5100
  • Fax: 219-465-9502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28232238B
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number28232238A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN069666
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: