Organization
IRIS KETAMINE & INFUSIONS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN GODDARD NP (OWNER)
(866) 218-5620
Entity
Organization
Contact information
Practice address
9025 COLDWATER RD STE 200, FORT WAYNE, IN 46825-2097
(866) 218-5620
(260) 888-2322
Mailing address
9025 COLDWATER RD STE 200, FORT WAYNE, IN 46825-2097
(866) 218-5620
(260) 888-2322
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
12/14/2023
Last updated
12/14/2023
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