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General NPI Number Information
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NPI Number | 1487990230
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Entity Type | Individual
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Provider Name | JACQUELYN RAQUEL ADLEY NP-C
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Gender | Female
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Dates
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Enumeration Date | 12/26/2012
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 10012 CALUMET AVE STE A
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City | MUNSTER
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State | IN
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Zip | 46321-4055
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Country | US
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Telephone | 219-227-5119
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Fax | 219-227-5190
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Provider Business Mailing Address
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Address Line | 1426 GATES DR
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City | SCHERERVILLE
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State | IN
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Zip | 46375-6014
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71004271A
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License Number State | IN
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