Healthcare Provider Details

I. General information

NPI: 1952985798
Provider Name (Legal Business Name): NWI HEALTH & WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2021
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1051 SOUTHPOINT CIR STE F
VALPARAISO IN
46385-6256
US

IV. Provider business mailing address

1051 SOUTHPOINT CIR STE F
VALPARAISO IN
46385-6256
US

V. Phone/Fax

Practice location:
  • Phone: 219-252-4892
  • Fax:
Mailing address:
  • Phone: 219-252-4892
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LYNN MCDONALD
Title or Position: CREDENTIALING
Credential:
Phone: 219-769-1670