Provider Demographics
NPI:1063010254
Name:VAN KEPPEL, LEAH C
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:C
Last Name:VAN KEPPEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 W 150 N
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6020
Mailing Address - Country:US
Mailing Address - Phone:219-869-4717
Mailing Address - Fax:
Practice Address - Street 1:201 W 150 N
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6020
Practice Address - Country:US
Practice Address - Phone:219-869-4717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-11
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula