Provider Demographics
NPI:1427409135
Name:VANDER LUITGAREN, JAN (RN)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:VANDER LUITGAREN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5897 SHALLOW WATER LN
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-8521
Mailing Address - Country:US
Mailing Address - Phone:317-410-0319
Mailing Address - Fax:
Practice Address - Street 1:5897 SHALLOW WATER LN
Practice Address - Street 2:
Practice Address - City:BARGERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46106-8521
Practice Address - Country:US
Practice Address - Phone:317-410-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-23
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28133402A163WN1003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WN1003XNursing Service ProvidersRegistered NurseNutrition Support