Individual
MARILYN ANGELA RECKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7211
(260) 435-7211
Mailing address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7211
(260) 435-7211
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000383
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000639294
BC/BS
IN
01
—
000000659918
BC/BS
IN
05
—
0074547
—
OH
01
—
P00775307
RAILROAD MEDICARE
IN
Enumeration date
07/16/2006
Last updated
01/24/2025
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