Individual
MRS. MARY EMILY TITCOMB
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
1717 S CALHOUN ST, FORT WAYNE, IN 46802-5257
(260) 458-2641
(260) 458-3093
Mailing address
PO BOX 11949, FORT WAYNE, IN 46862-1949
(260) 458-2641
(260) 458-3093
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
28116030A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
84474-06
PNP
IN
Enumeration date
08/17/2006
Last updated
07/08/2007
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