Provider Demographics
NPI:1912695362
Name:MEZA, ROSARIO (NP-C)
Entity Type:Individual
Prefix:
First Name:ROSARIO
Middle Name:
Last Name:MEZA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3435 172ND ST
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46323-2810
Mailing Address - Country:US
Mailing Address - Phone:219-680-8936
Mailing Address - Fax:
Practice Address - Street 1:4900 E 107TH CT
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46307-2862
Practice Address - Country:US
Practice Address - Phone:219-472-0309
Practice Address - Fax:219-472-0089
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-25
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71013873A363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily