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Individual

MATTHEW P. CONNOR

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 432-2297
(260) 479-4602
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3514
(260) 479-3520

Taxonomy

Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
71005855A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201329910
IN
Enumeration date
10/09/2015
Last updated
08/25/2021
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