Individual
HARRISON GLEN WALTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
621 MEMORIAL DR STE 502, SOUTH BEND, IN 46601-1075
(574) 647-5875
(574) 647-5878
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
(574) 647-2129
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71015471A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300076205
—
IN
Enumeration date
05/03/2021
Last updated
07/23/2024
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