Individual
TYRA KARMELLE GRISCHKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2101 E COLISEUM BLVD, FORT WAYNE, IN 46805-1445
(260) 257-6831
Mailing address
8219 AUBURN RD, FORT WAYNE, IN 46825-3017
(260) 267-3457
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/28/2024
Last updated
12/16/2024
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