Individual
JESSICA SHAYE PROXMIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4402 E STATE BLVD, FORT WAYNE, IN 46815-6917
(260) 425-5500
(260) 425-5505
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71008120A
IN
363LF0000X
Family Nurse Practitioner
9455542
FL
Other
Enumeration date
05/22/2017
Last updated
04/10/2023
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