Individual
DORINDA SUE MOSBRUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2512 E DUPONT RD STE 200, FORT WAYNE, IN 46825
(260) 748-3650
(260) 748-3651
Mailing address
2512 E DUPONT RD STE 200, FORT WAYNE, IN 46825-1609
(260) 748-3650
(765) 622-0126
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71005500A
IN
363LF0000X
Family Nurse Practitioner
71005500A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1090735
INDIANA BCBS
IN
05
—
201301240
—
IN
01
—
P02018855
RAILROAD MEDICARE
IN
Enumeration date
06/11/2015
Last updated
02/07/2019
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