Individual
AMY J GILLESPIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 203-9600
(260) 739-6167
Mailing address
10351 DAWSONS CREEK BLVD, SUITE A-1, FORT WAYNE, IN 46825-1904
(260) 203-9600
(260) 739-6167
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71004916A
IN
363LP0200X
Pediatric Nurse Practitioner
71004916A
IN
Other
Enumeration date
06/02/2014
Last updated
06/02/2014
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