Individual
BRIANA VAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
12121 BREEZY KNOLL CT, FORT WAYNE, IN 46818-8529
(260) 637-0556
Mailing address
12121 BREEZY KNOLL CT, FORT WAYNE, IN 46818-8529
(260) 637-0556
Taxonomy
Speciality
Code
Description
License number
State
246ZE0600X
Electroneurodiagnostic Specialist/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
246ZE0600X
24
IN
Enumeration date
06/16/2021
Last updated
06/16/2021
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