Individual
PORSCHE BIANCA WEST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2269 W 25TH AVE, GARY, IN 46404-3367
(219) 944-4160
Mailing address
2269 W 25TH AVE, GARY, IN 46404-3367
(708) 275-6933
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71013960A
IN
Other
Enumeration date
04/12/2023
Last updated
09/23/2024
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