Individual
JENNA RAE SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11141 PARKVIEW PLAZA DR STE 320, FORT WAYNE, IN 46845-1714
(260) 425-5400
(260) 425-5417
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163WU0100X
Urology Registered Nurse
28209700A
IN
363L00000X
Nurse Practitioner
Primary
71015347A
IN
Other
Enumeration date
03/25/2024
Last updated
09/03/2024
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