Individual
MRS. SANDRA SUE CHARLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
326 N SAWYER RD, KENDALLVILLE, IN 46755-2573
(260) 349-9166
(260) 349-9175
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71012524A
IN
Other
Enumeration date
04/29/2022
Last updated
04/02/2024
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