LUXE LIFE MEDICAL LLC NPI 1720684673

NPI Information

NPI: 1720684673
Provider Name: LUXE LIFE MEDICAL LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

CLIA Number: 15D2221828

Address:
606 LINCOLNWAY
VALPARAISO, IN
ZIP 46383
Phone: (219) 247-4003
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LUXE LIFE MEDICAL LLC is a family nurse practitioner in Valparaiso, IN. LUXE LIFE MEDICAL LLC NPI is 1720684673. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

606 LINCOLNWAY
VALPARAISO, IN
ZIP 46383-728
Phone: (219) 247-4003

The provider's authorized official is Elizabeth Victoria Moerman .
The authorized official title is Owner/fnp and has the following contact phone number (219) 247-4003.

The CLIA number assigned to this NPI record is 15D2221828 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 12/7/2020 and was last updated on 9/6/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	300032267	MEDICAID	INDIANA
2	IN4530	OTHER	INDIANA	IN MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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