Individual
MARY JO GURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, WHNP-BC
Contact information
Practice address
10215 AUBURN PARK DR, FORT WAYNE, IN 46825-2387
(260) 490-2229
(260) 490-3807
Mailing address
10215 AUBURN PARK DR, FORT WAYNE, IN 46825-2387
(260) 490-2229
(260) 490-3807
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28161564A
IN
363LW0102X
Women's Health Nurse Practitioner
Primary
71004092A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201091680
—
IN
Enumeration date
07/09/2012
Last updated
01/22/2014
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