Individual
GUINEVERE M NILLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
7910 W JEFFERSON BLVD STE 108, FORT WAYNE, IN 46804-4159
(260) 484-8830
(260) 483-1911
Mailing address
6610 MUTUAL DR, FORT WAYNE, IN 46825-4236
(260) 484-8830
(260) 483-1911
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10001910A
IN
363A00000X
Physician Assistant
—
IN
Other
Enumeration date
04/30/2015
Last updated
07/23/2020
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