Individual
MRS. MARY JO MOREY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
17501 GENERATIONS DR, SOUTH BEND, IN 46635-1589
(574) 234-0049
(574) 234-0053
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71001590A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000849526
BCBS BMG ADVANCED CARDIO SPECIALIST
IN
05
—
200491240
—
IN
05
—
200491240A
—
IN
01
—
P01373877
RR MEDICARE
IN
Enumeration date
07/07/2005
Last updated
07/21/2022
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