Provider Demographics
NPI:1770657959
Name:RAMIREZ, CONNIE J (NP)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:J
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:J
Other - Last Name:VARGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:505 WEST US HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2650
Mailing Address - Country:US
Mailing Address - Phone:219-322-3311
Mailing Address - Fax:219-322-8210
Practice Address - Street 1:505 WEST US HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-2650
Practice Address - Country:US
Practice Address - Phone:219-322-3311
Practice Address - Fax:219-322-8210
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000714363LF0000X
IN71000714A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000489424OtherANTHEM BCBS
IN200296640Medicaid
IN000000489424OtherANTHEM
IN000000489424OtherANTHEM BCBS
142650LMedicare PIN
IN200296640Medicaid