Individual
MRS. LISA ANN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN, RN, AGCNS, NP-C
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 415-6175
Mailing address
1580 VINTNERS WAY, FORT WAYNE, IN 46845-8798
(260) 415-6175
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
AG05180066
IN
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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