Individual
NANCY ANNE PUDLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6913 N MAIN ST STE 200, GRANGER, IN 46530-8039
(574) 647-4540
(574) 647-2971
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01065123A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000721926
ANTHEM TRADITONAL
IN
05
—
200908380
—
IN
Enumeration date
05/28/2008
Last updated
03/31/2021
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