Individual
MAKAYLA BLAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
11104 PARKVIEW CIRCLE DR STE 110, FORT WAYNE, IN 46845-1673
(260) 425-6780
(260) 425-6615
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71010155A
IN
363LF0000X
Family Nurse Practitioner
Primary
71010155A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300040816
—
IN
Enumeration date
07/17/2020
Last updated
04/02/2026
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