Individual
MS. ELIZABETH RENE DEPEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSN, FNP-BC
Contact information
Practice address
1234 E DUPONT RD, SUITE 6, FORT WAYNE, IN 46825-1545
(260) 480-2600
(260) 496-8077
Mailing address
3702 NEW VISION DR BLDG B, FORT WAYNE, IN 46845-1703
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28141226A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000799124
ANTHEM
IN
01
—
188220
PTAN
IN
05
—
200891390
—
IN
01
—
3123819
OH MEDICIAD
IN
Enumeration date
01/12/2007
Last updated
10/01/2018
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