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CHANDRA LEIGH PETRO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
7333 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6280
(260) 458-3830
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3516
(260) 479-3520

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71004173A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
201120880
IN
Enumeration date
11/15/2012
Last updated
09/02/2020
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