Individual
WANDA BONTRAGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
404 MOUNT VERNON DR, GOSHEN, IN 46526-1432
(574) 533-4933
Mailing address
404 MOUNT VERNON DR, GOSHEN, IN 46526-1432
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
31000534A
IN
Other
Enumeration date
10/13/2011
Last updated
10/13/2011
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