Individual
EMMA JOY NORDSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2705 N LEBANON ST STE 300, LEBANON, IN 46052-8622
(765) 485-8649
(765) 485-8650
Mailing address
2605 N LEBANON ST, LEBANON, IN 46052-1476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01070698A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201088750
—
IN
Enumeration date
06/02/2010
Last updated
10/11/2023
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