Individual
JESSICA A GNOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
420 W 4TH ST, MISHAWAKA, IN 46544-1948
(574) 307-7673
(574) 307-7692
Mailing address
951 TRANSPORT DR, VALPARAISO, IN 46383-8434
(219) 462-7173
(219) 465-9507
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
28177569A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28177569A
LICENSE RN
IN
Enumeration date
04/15/2014
Last updated
04/15/2014
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