Individual
BERNITA FLYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3919 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6811
(260) 436-7722
Mailing address
6330 PINE MEADOWS LN, FORT WAYNE, IN 46835-3800
(260) 486-3663
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
28079791A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100465770
—
IN
Enumeration date
08/13/2014
Last updated
08/13/2014
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