Healthcare Provider Details

I. General information

NPI: 1912695362
Provider Name (Legal Business Name): ROSARIO MEZA NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 E 107TH CT
WINFIELD IN
46307-2862
US

IV. Provider business mailing address

3435 172ND ST
HAMMOND IN
46323-2810
US

V. Phone/Fax

Practice location:
  • Phone: 219-472-0309
  • Fax: 219-472-0089
Mailing address:
  • Phone: 219-680-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71013873A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: