Individual
MARISHA A KLINGENBERGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2200 RANDALLIA DR, FORT WAYNE, IN 46805-4638
(260) 373-6070
(260) 373-6704
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71001042A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200332990
—
IN
Enumeration date
05/15/2006
Last updated
06/05/2024
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