Individual
ANN E RADEMAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11108 PARKVIEW CIRCLE DR, ATTENTION: POLLY BALOSKI, FORT WAYNE, IN 46845-1730
(260) 266-5700
(260) 266-5920
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71001857A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000641096
ANTHEM
IN
05
—
200507030
—
IN
01
—
P00825411
R.R. MEDICARE
IN
Enumeration date
08/16/2005
Last updated
03/25/2021
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