Provider Demographics
NPI:1245242056
Name:KUYPER, JAMI L (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:JAMI
Middle Name:L
Last Name:KUYPER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 45TH STREET
Mailing Address - Street 2:STE. 201
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321
Mailing Address - Country:US
Mailing Address - Phone:219-922-5550
Mailing Address - Fax:219-922-5555
Practice Address - Street 1:9034 COLUMBIA AVENUE
Practice Address - Street 2:SUITE 300
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321
Practice Address - Country:US
Practice Address - Phone:219-836-0296
Practice Address - Fax:219-836-0570
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041207191163W00000X
IN28112859A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse