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Individual

JACLYN ANN FUSCO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
100 NAVARRE PL STE 5550, SOUTH BEND, IN 46601-1169
(574) 647-2550
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28265298A
IN
363LP0200X
Pediatric Nurse Practitioner
Primary
202325197
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
300078118
IN
Enumeration date
03/14/2023
Last updated
04/02/2024
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