Individual
JACK CHITENJE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13914 BOULDER CANYON DR, FISHERS, IN 46038-5361
(574) 210-9966
Mailing address
13914 BOULDER CANYON DR, FISHERS, IN 46038-5361
(574) 210-9966
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
PENDING
IN
Other
Enumeration date
07/03/2019
Last updated
07/03/2019
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