Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Northeast Internal Medicine

Organization Primary Care Nurse Practitioner · NPI 1366859779

Northeast Internal Medicine is a Primary Care Nurse Practitioner in Lagrange, Indiana. Works from 2 locations. Licensed in Indiana.

Licensed in
IN
In the registry since
2014

Practice location Address checks out

2500 N Detroit St
Lagrange, IN 46761-1158
Phone: (260) 463-2133
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 610 N Sawyer Rd, Kendallville, IN 46755-2566 — (260) 347-5592

Specialties & licences

Primary Care Nurse Practitioner (primary) Taxonomy 363LP2300X · Licence 71004993A (IN)

Record details

NPI number1366859779
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tara Gilmore — Business Office Manager · (260) 463-2133
NPI enumeratedJuly 17, 2014
Last updated in NPPESFebruary 27, 2019
Mailing addressPo Box 236, Lagrange, IN 46761-0236

Other providers in Lagrange