Individual
JENNIFER L GORANSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11109 PARKVIEW PLAZA DR, FORT WAYNE, IN 46845-1701
(260) 672-6620
(260) 672-6639
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
01086547A
IN
Other
Enumeration date
03/26/2020
Last updated
06/28/2022
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