Individual
LEANNA CAROL FANDL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
6615 S BOUNDARY RD, PORTAGE, IN 46368-1373
(219) 787-8662
(219) 787-8420
Mailing address
6615 S BOUNDARY RD, PORTAGE, IN 46368-1373
(219) 787-8662
(219) 787-8420
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
28105935A
IN
Other
Enumeration date
11/03/2011
Last updated
01/30/2015
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