Individual
JERRI JAKICH-ORTIZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
2100 N MAIN ST STE 304, CROWN POINT, IN 46307-1877
(574) 546-1900
(574) 546-1999
Mailing address
PO BOX 10299, FORT WAYNE, IN 46851-0299
(574) 546-1900
(574) 546-1999
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28090074A
IN
363L00000X
Nurse Practitioner
71003055A
IN
363LF0000X
Family Nurse Practitioner
Primary
71003055A
IN
363LF0000X
Family Nurse Practitioner
71003055B
IN
Other
Enumeration date
09/09/2009
Last updated
03/25/2021
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