Individual
VERNICE STREET
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRTT
Contact information
Practice address
2121 LAKE AVE, FORT WAYNE, IN 46805-5100
(260) 426-5431
Mailing address
1918 ARDMORE AVE APT 43, FORT WAYNE, IN 46802-4822
(260) 246-8816
Taxonomy
Speciality
Code
Description
License number
State
2278C0205X
Critical Care Certified Respiratory Therapist
Primary
3003273A
IN
Other
Enumeration date
02/11/2022
Last updated
02/11/2022
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