Individual
JOLENE DURHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.A.
Contact information
Practice address
254 WEST US 6, LIGONIER, IN 46767
(260) 894-9909
Mailing address
1510 OSOLO RD, ELKHART, IN 46514-4122
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
06002230
IN
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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