Individual
JOANN FLY-SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2106 MORTHLAND DR # 1149, VALPARAISO, IN 46383-5914
(469) 667-7972
(888) 379-3899
Mailing address
2106 MORTHLAND DR # 1149, VALPARAISO, IN 46383-5914
(469) 667-7972
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300086594
—
IN
Enumeration date
07/16/2024
Last updated
07/16/2024
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