Individual
BRIANNA LATISNERE-BLOSSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2006 S MAIN ST STE A, GOSHEN, IN 46526-5232
(574) 535-9100
(574) 535-1020
Mailing address
2006 S MAIN ST STE A, GOSHEN, IN 46526-5232
(574) 535-9100
(574) 535-1020
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004633A
IN
Other
Enumeration date
08/16/2024
Last updated
11/07/2024
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