Individual
HIBAJENE CHISONGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1700 MISHAWAKA AVE, SOUTH BEND, IN 46634-7111
(574) 229-9012
Mailing address
1700 MISHAWAKA AVE, SOUTH BEND, IN 46615-1408
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
28181907A
IN
363LF0000X
Family Nurse Practitioner
Primary
4704262598
MI
Other
Enumeration date
11/27/2013
Last updated
03/07/2019
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