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Individual

MRS. JENNIFER LEIGH DEFAUW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1101 GLENDALE BLVD # 102A, VALPARAISO, IN 46383-3767
(219) 464-9521
Mailing address
2753 KERRY DR, VALPARAISO, IN 46385-0031
(219) 331-8183

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71013190A
IN

Other

Enumeration date
09/14/2022
Last updated
11/30/2022
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