Individual
IRENE PONCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
2251 DUBOIS DR, WARSAW, IN 46580-3212
(574) 269-2777
Mailing address
PO BOX 1296, WARSAW, IN 46581-1296
(574) 268-9640
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
28139540
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000323317
ANTHEM BC BS
IN
05
—
200315210A
—
IN
Enumeration date
05/18/2006
Last updated
10/08/2013
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