Provider Demographics
NPI:1568015592
Name:KLISURICH, KARI
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:
Last Name:KLISURICH
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 1:3145 45TH ST STE M
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:IN
Mailing Address - Zip Code:46322-3292
Mailing Address - Country:US
Mailing Address - Phone:219-922-9150
Mailing Address - Fax:219-922-9180
Practice Address - Street 1:3145 45TH ST STE M
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-3292
Practice Address - Country:US
Practice Address - Phone:219-922-9150
Practice Address - Fax:219-922-9180
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28209136A163W00000X
IN71009330B363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse