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General NPI Number Information
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NPI Number | 1710638432
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Entity Type | Individual
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Provider Name | JOOS MOERLAND
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Gender | Male
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 01/21/2022
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Provider Practice Location Address
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Address Line | 104 E CULVER RD STE 102
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City | KNOX
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State | IN
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Zip | 46534-2241
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Country | US
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Telephone | 574-772-7918
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Fax |
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Provider Business Mailing Address
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Address Line | 6141 S 50 E
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City | NORTH JUDSON
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State | IN
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Zip | 46366-8432
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Country | US
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Telephone | 574-249-2476
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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 | 71012114A
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License Number State | IN
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