Individual
JODI L CHAMBERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3946 ICE WAY, FORT WAYNE, IN 46805-1018
(260) 266-4007
(260) 266-4008
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10000487A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300006248
—
IN
01
—
970018667
RAIL ROAD MEDICARE
IN
Enumeration date
08/17/2005
Last updated
10/12/2022
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