Individual
MARY GRACE BOOKMYER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
(260) 748-3650
Mailing address
11512 TALL OAK RUN, FORT WAYNE, IN 46845-8604
(260) 425-0096
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10004720A
IN
Other
Enumeration date
01/29/2025
Last updated
01/29/2025
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