Individual
MIGNONETTE DARLENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2100 N MAIN ST # 304, CROWN POINT, IN 46307-1877
(574) 546-1900
(574) 546-1999
Mailing address
PO BOX 10299, FORT WAYNE, IN 46851-0299
(574) 546-1900
(574) 546-1999
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71006769A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
71006769A
APRN LICENSE
IN
Enumeration date
02/16/2017
Last updated
05/23/2022
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