Organization
MAPLE LEAF PAIN RELIEF
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHANNON ROBERTS (OWNER)
(214) 284-1420
Entity
Organization
Contact information
Practice address
908 E IRELAND RD, SOUTH BEND, IN 46614-2664
(214) 284-1420
Mailing address
6628 GREENRIDGE DR, INDIANAPOLIS, IN 46278-1184
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
11/07/2016
Last updated
11/07/2016
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