Individual
LORETTA BAZUR-PERSING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
3025 N ANTHONY BLVD, FORT WAYNE, IN 46805-2723
(260) 740-3031
Mailing address
9900 BREN RD E, MINNETONKA, MN 55343-9664
(260) 498-9252
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
71002754A
IN
363LF0000X
Family Nurse Practitioner
Primary
71002754A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200985990
—
IN
Enumeration date
12/02/2008
Last updated
07/22/2020
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