Individual
BRIANNE ELIZABETH MAHONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
610 N MICHIGAN ST STE 400, SOUTH BEND, IN 46601-1081
(574) 647-8120
(574) 647-8111
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71009237A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236040323
MEDICARE PTAN
IN
01
—
257270020
MEDICARE PTAN
IN
05
—
300030531
—
IN
Enumeration date
07/17/2019
Last updated
03/30/2021
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