Individual
LOIS ELAINE DURYEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
330 LAKEVIEW DR, GOSHEN, IN 46528-9365
(574) 533-1234
(574) 537-2652
Mailing address
PO BOX 809, GOSHEN, IN 46527-0809
(574) 533-1234
(574) 537-2652
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
02001183A
IN
2084P0800X
Psychiatry Physician
02161
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891763629
—
IA
Enumeration date
03/09/2006
Last updated
07/23/2009
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