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Individual

ANDREA PLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP-C

Contact information

Practice address
7916 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 434-6412
(260) 434-6395
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 434-6403
(260) 434-6395

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
28229563A
IN
363LF0000X
Family Nurse Practitioner
28229563A
IN
363LF0000X
Family Nurse Practitioner
Primary
71011572
IN

Other

Enumeration date
07/11/2021
Last updated
07/20/2022
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