MEDICARE: MRS. LAURA RODRIGUEZ APN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SC0200X	Critical Care Medicine Clinical Nurse Specialist	28141035A	IN

General Provider Information

NPI Number	:	1174642763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA RODRIGUEZ APN

Provider Business Mailing Address
First Line	:	8913 DOUBLETREE DR S
Second Line	:
City	:	CROWN POINT
State	:	IN
Zip	:	46307-9384
Country	:	US
Telephone Number	:	219-669-8191
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 BROADWAY
Second Line	:	SUITE A-J
City	:	MERRILLVILLE
State	:	IN
Zip	:	46410-2601
Country	:	US
Telephone Number	:	219-884-9180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/23/2014

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