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NPI Code Detail

MEDICARE: LADY ANNE MARGOTTE PLASABAS AGACNP-BC

MEDICARE: LADY ANNE MARGOTTE PLASABAS AGACNP-BC
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
1363LG0600XGerontology Nurse Practitioner71015607AIN

General Provider Information

NPI Number : 1972331023
Entity Type Code : Individual
Provider Name (Legal Business Name) : LADY ANNE MARGOTTE PLASABAS AGACNP-BC
Provider Business Mailing Address
First Line : 8558 BROADWAY
Second Line :
City : MERRILLVILLE
State : IN
Zip : 46410-7032
Country : US
Telephone Number : 219-392-7084
Fax Number : 219-703-6854
Provider Business Practice Location Address
First Line : 100 W CHICAGO AVE STE F
Second Line :
City : EAST CHICAGO
State : IN
Zip : 46312-3261
Country : US
Telephone Number : 219-392-7016
Fax Number : 219-947-6904
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2024
Last Update Date : 08/08/2024

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Directions to “ LADY ANNE MARGOTTE PLASABAS AGACNP-BC” Practice Location

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