Individual
MRS. MARY ELIZABETH FORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
PARKVIEW HEALTH, 11108 PARKVIEW CIRCLE DR, DOOR 10, FT. WAYNE, IN 46845
(260) 266-1000
Mailing address
1828 S. TYLAND BLVD., NEW HAVEN, IN 46774
(260) 615-1031
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
71010812A
IN
363LF0000X
Family Nurse Practitioner
71010812A
IN
Other
Enumeration date
02/04/2021
Last updated
02/04/2021
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