Individual
JONATHAN NOTELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
1721 MAGNAVOX WAY, FORT WAYNE, IN 46804-1537
(260) 748-3650
(260) 748-3651
Mailing address
PO BOX 670, HUNTERTOWN, IN 46748-0670
(260) 748-3650
(260) 748-3651
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28202205A
IN
363L00000X
Nurse Practitioner
Primary
71006122A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003883
BCBS
IN
05
—
201350810
—
IN
Enumeration date
01/25/2016
Last updated
08/14/2019
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