Individual
KELSEY LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2231 CAREW ST, FORT WAYNE, IN 46805-4713
(260) 373-5436
(260) 373-6470
Mailing address
11109 PARKVIEW PLAZA DRIVE, MAILBOX 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28227063A
IN
363L00000X
Nurse Practitioner
Primary
71010126A
IN
Other
Enumeration date
04/07/2020
Last updated
10/14/2022
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