Organization
ROUNDING PROVIDERS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN L LETZ DNP (PRESIDENT)
(650) 924-1174
Entity
Organization
Contact information
Practice address
6326 CONSTITUTION DR, FORT WAYNE, IN 46804-1518
(650) 924-1174
Mailing address
6326 CONSTITUTION DR, FORT WAYNE, IN 46804-1518
(650) 924-1174
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
71000749A
IN
363LF0000X
Family Nurse Practitioner
Primary
71001329A
IN
Other
Enumeration date
04/29/2010
Last updated
02/05/2021
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