Provider Demographics
NPI:1437763299
Name:CALDERONE, LOREN MICHELLE (NP-C)
Entity Type:Individual
Prefix:
First Name:LOREN
Middle Name:MICHELLE
Last Name:CALDERONE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LOREN
Other - Middle Name:MICHELLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:55346 FIR RD
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-4214
Mailing Address - Country:US
Mailing Address - Phone:574-220-0619
Mailing Address - Fax:
Practice Address - Street 1:710 PARK PL
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3519
Practice Address - Country:US
Practice Address - Phone:574-273-6776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71010314A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily