Healthcare Provider Details

I. General information

NPI: 1518065044
Provider Name (Legal Business Name): SUZAN V VON EHR APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 06/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 ALLISON CIR
VALPARAISO IN
46383-3973
US

IV. Provider business mailing address

2410 ALLISON CIR
VALPARAISO IN
46383-3973
US

V. Phone/Fax

Practice location:
  • Phone: 219-707-9237
  • Fax: 219-961-8300
Mailing address:
  • Phone: 219-707-9237
  • Fax: 219-961-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71000056
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: