Individual
MRS. HALEY ANNE BYWATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
621 MEMORIAL DR STE 100, SOUTH BEND, IN 46601-1063
(574) 647-1100
(574) 647-5907
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
4704393582
MI
363LF0000X
Family Nurse Practitioner
Primary
71012499A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801540034
—
MI
05
—
300066388
—
IN
Enumeration date
02/07/2022
Last updated
10/29/2024
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