Individual
MRS. JENNA L SHOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, APRN, PMHNP-BC
Contact information
Practice address
1690 BROADWAY, BUILDING 19, SUITE 10, FORT WAYNE, IN 46802-2012
(260) 200-4940
(949) 404-6540
Mailing address
1690 BROADWAY, BUILDING 19, SUITE 10, FORT WAYNE, IN 46802-2012
(260) 200-4940
(949) 404-6540
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
28184986A
IN
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
71009466A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300031451
—
IN
Enumeration date
07/23/2019
Last updated
05/19/2023
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