Individual
BRANDON EMRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 110, FORT WAYNE, IN 46845-1673
(260) 425-6780
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
(260) 266-6013
(260) 458-5831
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28217961A
IN
363L00000X
Nurse Practitioner
Primary
71007787A
IN
Other
Enumeration date
12/14/2017
Last updated
02/14/2018
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